Iliolumbar Fusion In The Management Of Sacral Agenesis A Follow-Up Report

Earl E. VanDerwerker, Jr., M.D.

Approximately a year ago, we submitted a preliminary report on a case of "Iliolumbar Fusion in the Management of Sacral Agenesis" ( ICIB, Vol. V, No. 8, May 1966). A follow-up report is presented below.

The child is now six years of age. According to the X-ray evidence, the iliolumbar grafts have been absorbed. Nevertheless, stability has been obtained, so that the telescoping of the pelvis into the abdominal cavity has apparently been minimized, if it has not been entirely eliminated. The "hinge" motion, which allows the pelvis to move anteriorly in relation to the spine, pivoting on the remaining lumbar vertebra, is essentially the same as was evident clinically in March 1966.

Intravenous pyelograms, which were taken on June 9, 1967, with the boy (1) sitting relaxed, and (2) sitting with body weight on the hands, showed no apparent change in contour or kinking of the ureters in these two positions, indicating that the telescoping effect on the ureters has apparently been eliminated. The patient has bowel continence but is incontinent of urine, necessitating a urinary reservoir.

Prosthetic fitting has progressed to a bucket that is well molded about the lower thoracic cage and above the iliac crests, bilateral Canadian hip joints, and knee joints (Fig. 1 and 2 , Fig. 3 and Fig. 4 ). The child is stable in the prosthesis and ambulates with a swing-through gait. Tolerance to the appliance has increased to three hours at a time; it is then removed and reapplied. He is essentially wearing it all day, and this past winter attended school for half a day. He is unable to negotiate stairs as yet, but is able to ambulate on a ramp.

Some difficulty has been encountered in flexing the hip joints when attempting to sit. This problem will probably necessitate a modification of these joints.

All things considered, we have been satisfied with the results to date and feel that iliolumbar fusion is a procedure worthy of consideration by others in similar cases.

According to a recent edition of The Hosmer Prosthetic News, the company's new flexion wrist is being well received.

In the past, wrist flexion has been provided by a separate unit, thus adding extra length, weight, and cost to the prosthesis. The new flexion wrist (Fig. 1 ) combines both wrist rotation and flexion in one unit. The weight and length are about the same as for the former wrist unit alone.

Fig. 2 , Fig. 3 and Fig. 4 show the flexion wrist with terminal device in straight position, in the first pesition of 30 degrees of flexion, and in the second position of 50 degrees of flexion. The unit automatically locks in one of these three positions. A control button is depressed manually to move to a new position of flexion.

The terminal device rotates in the wrist unit, and the amount of friction resisting this rotation is adjusted with a set screw.

The flexion wrist is available in three sizes: the FW-500 is 2 inches OD (adult size); the FW-300 is 1-3/4 inches OD (medium-small); and the FW-200 is 1 1/2 inches OD, i.e., sized for children.

Earl E. VanDerwerker, Jr., M.D. is associated with the Newington Hospital for Crippled Children Newington, Connecticut