Seven cases of sacral agenesis ranging from total vertebral loss below the first lumbar vertebra to the absence of a hemisacrum with lumbar hypoplasia are presented. We pursued an agressive therapeutic approach to retain the patient's lower extremities and suggest that when proprioception is present preservation of the lower extremities is superior to amputation and prosthetic replacement.
In four of the five severe and intermediate cases the patients arc walking with the aid of forearm crutches and braces and have been followed for an average of five years. Maternal diabetes was proved in four of the seven patients. Roentgenographic survey of five patients' parents revealed only one instance of spina bifida occulta at the level of the first sacral vertebra. Chromosome analysis was normal in all seven patients.