CAUDAL REGRESSION SYNDROME - TYPES III AND IV

Caudal Dysplasia Sequence; Caudal Regression Sequence; Caudal Dysgenesis Syndrome; Sacral Regression; Sacral Agenesis; Lumbo Sacral Agenesis; Sacral Defect with Anterior Meningocele; Sacral Regression Syndrome; Sacral Agenesis Syndrome

Caudal Regression Syndrome (CRS) is a rare congenital disorder that occurs when the lowest half of the body (caudal) does not fully form in utero.

There are four main types of CRS. Types I and II are considered mild forms with coccyx (tailbone) absence without deficits in functionality. Types III and IV are the most severe with systemic and neurological complications.

The exact cause of this disorder is unknown. It occurs in people with no history of the condition in their family. Multiple genetic and environmental risk factors are thought to be contributory to this condition. Maternal diabetes, genetic predisposition, and vascular hypoperfusion have been linked to CRS.

Diagnostic testing: A preliminary diagnosis can be made in utero by ultrasound, during the first trimester of pregnancy, but must be confirmed after birth. The severity of the disease is determined by examination of the newborn by postnatal ultrasound and a MRI (magnetic resonance imaging).

Physical findings: Individuals with CRS may have:

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  Partial agenesis (absence) of the thoracolumbosacral spine;

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  Imperforate (closed) anus;

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  Malformed genitalia;

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  Bilateral renal dysplasia or aplasia;

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  Pulmonary hypoplasia;

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  In severe cases, rotation and fusion of the lower extremities;

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  Spinal cord defects, and related motor and sensory deficits;

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  Genitourinary defects (i.e. unilateral or bilateral renal absence, renal displacement, and fused urinary tubes);

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  Gastrointestinal defects (inability to control bowel movements and closed anus); and

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  Cardiac disease.

ICD-9: 742.9

The prognosis depends on the severity of spinal involvement and associated malformations. Early neonatal (the first 28 days of life) death in the severe forms occurs from cardiac, renal, and respiratory complications.

There is no cure for this disorder because the primary pathology is irreversible. Treatment is supportive and symptomatic. Individuals with severe forms of CRS require ongoing neurological, orthopedic and renal interventions. Surgical intervention, such as a colostomy is performed to treat an imperforate (closed) anus. Physical and occupational therapies are used to improve quality of life.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

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  Clinical history and examination that describes the diagnostic features of the impairment, as well as the related functional limitations.

Suggested Listings for Evaluation:

REMARKS