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.