Discussion
Sacral HV and CLSJK is a very rare abnormality and the natural progress
is unclear.12 Daher et al., reported a 10 month old
infant with anorectal malformation who underwent rectal surgery, which
in further examinations, a HV at S1-S2 level was found but they did not
mention the details of the spine problem and did not give an explanation
about its follow-up 6. Karaeminogullari et al.,
reported an 11-month-old boy who was treated surgically for congenital
heart disease with a sacral HV at S2-S3 level with no thoracic or lumbar
scoliosis. They followed the patient for seven years and no symptoms
such as lower back pain in either standing or seating positions were
found. Also the gait, muscle power, sensation and reflexes for the
lumbar and sacral nerves were all normal 7. Whereas
Ansari et al., reported two cases with L5-S1 HV who both had functional
kyphosis at the lumbosacral junction. Both walked with a waddling gait
and flexed hips and had bowel and bladder difficulties with abnormal
urodynamic testing. 13. It is notable that patients
showed similar symptoms and clinical course to our report. The
difference is that our patient had a HV at S1-S2 level.
Winter et al. described 41 degree of deformity advancement following
dorsal HV in a sample of 130 patients over 6 years.14Also, Nazareth et al have pointed out that that CLSJK like other
congenital kyphosis types should be treated before the appearance of
neurological symptoms. 9 In this regard, like other
congenital kyphosis types, CLSJK needs to be treated before neurological
symptoms present. However, even if adult surgery doesn’t totally resolve
neurological problems, it can still contribute to improvement.