Magnetic Resonance Imaging Analysis of Caudal Regression Syndrome and Concomitant Anomalies in Pediatric Patients

Abstract

Objective:The aim of this study was to evaluate the magnetic resonance imaging (MRI) findings of caudal regression syndrome (CRS) and concomitant anomalies in pediatric patients.Materials and Methods:A hospital-based cross-sectional retrospective study was conducted. The study group comprised 21 pediatric patients presenting to the Departments of Radiodiagnosis and Pediatric Surgery in a tertiary care hospital from May 2011 to April 2016. All patients were initially evaluated clinically followed by MRI.Results:In our study, 21 pediatric patients were diagnosed with sacral agenesis/dysgenesis related to CRS. According to the Pang's classification, 2 (9.5%) patients were Type I, 5 (23.8%) patients were Type III, 7 (33.3%) patients were Type IV, and 7 (33.3%) patients were of Type V CRS. Clinically, 17 (81%) patients presented with urinary incontinence, 6 (28.6%) with fecal incontinence, 9 patients (42.9%) had poor gluteal musculatures and shallow intergluteal cleft, 7 (33.3%) patients had associated subcutaneous mass over spine, and 6 (28.6%) patients presented with distal leg muscle atrophy. MRI showed wedge-shaped conus termination in 5 (23.8%) patients and bulbous conus termination in 3 (14.3%) patients above the L1 vertebral level falling into Group 1 CRS while 7 (33.3%) patients had tethered cord and 6 (28.6%) patients had stretched conus falling into Group 2 CRS.Conclusion:MRI is the ideal modality for detailed evaluation of the status of the vertebra, spinal cord, intra- and extra-dural lesions and helps in early diagnosis, detailed preoperative MRI evaluation and assessing concomitant anomalies and guiding further management with early institution of treatment to maximize recovery.

Congenital talipes equinovarus and congenital vertical talus secondary to sacral agenesis

“…Bowel problems are also common in patients with sacral agenesis, with up to 73% experiencing constipation38 and 29% experiencing faecal incontinence 39. Intermittent constipation and faecal incontinence have also been reported 40.…”

Continuous ultrasound‐guided sacral intervertebral block for postoperative analgesia in neonates

“…4 The last vertebra present varies from S4 to L5, and vertebral spinal malformation such spina bifida, block vertebra, hemivertebra, butterfly vertebra, and reversed sacral curvature could be present. 4 Various spinal cord anomalies were identified (extra and intradural lipoma, syrinx, lipomeningomyelocele, neurenteric cyst, diastematomyelia, intrasacral lipoma, and meningocele). 4 The conus medullaris could be as high as T12 or as low as S5, being wedged, blunted, stretched, or tethered.…”

“…4 Various spinal cord anomalies were identified (extra and intradural lipoma, syrinx, lipomeningomyelocele, neurenteric cyst, diastematomyelia, intrasacral lipoma, and meningocele). 4 The conus medullaris could be as high as T12 or as low as S5, being wedged, blunted, stretched, or tethered. 4 The thecal sac ends higher with higher levels of spinal agenesis.…”

Clinical and Radiological Characterization of an Infant with Caudal Regression Syndrome Type III

“…Reported risk factors Boruah et al [14] Triangular pelvis Diabetes Kumar et al [15] Bilateral grade V vesicoureteric reflux and situs inversus totalis Diabetes Zaw et al [16] -Diabetes Hashami et al [17] Partial agenesis of the corpus callosum and partial lobar holoprosencephaly Diabetes Vissarionov et al [18] Kyphosis, bilateral hip dysplasia -Balioglu et al [19] --…”