WOFAPS 2025 8th World Congress of Pediatric Surgery

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Poster - 352

Sacral ratio correlates with spinal and sacral anomalies in children with anorectal malformation

Alberto Gubert 1, Marc Georges 1, Sabine Vasseur Maurer 1, Leonor Trinidad Alamo-Maestre 2, Eleuthère Stathopoulos 1
1 Department of Pediatric Surgery, CHUV - Lausanne University Hospital, Lausanne, Switzerland
2 Department of Radiodiagnostic and Interventional Radiology, CHUV - Lausanne University Hospital, Lausanne, Switzerland

Purpose: In children born with anorectal malformation (ARM), sacral ratio (SR) is used for spinal and sacral assessment and as prognostic factor. We investigated correlation of SR with spinal and sacral malformations in children with ARM.

Method: Retrospective study of children with ARM managed in our center from 2000 to 2025. Patients investigated by x-ray and MRI were included. SR was measured by two observers on the best pelvis x-ray available. Spinal and sacral anatomy was assessed on MRI. Spinal anomaly included tethered cord, meningocele, lipoma, thickened filum; sacral anomaly was defined as dysplasia or agenesia of sacral vertebrae.

Results: 102 ARM patients out of 214 were included. ARM subtypes were 52 perineal fistula, 9 vestibular fistula, 9 rectobulbar fistula, 8 rectoprostatic fistula, 1 rectobladder neck fistula, 15 anal atresia, 2 anal stenosis, 5 cloaca, 1 pouch colon. 22/102 (21.6%) had spinal anomaly and 28/102 (27.5%) had sacral anomaly. Interobserver SR variability was not significant (0.66 ± 0.18 vs 0.65 ± 0.18, p=0.70). 69 ARM patients had neither spinal nor sacral anomaly; their SR was 0.70 ± 0.16. SR in children with ARM and spinal anomaly was significantly lower compared to children without spinal anomaly (0.53 ± 0.18 vs 0.69 ± 0.16, p=0.0007). SR in children with ARM and sacral anomaly was significantly lower compared to children without sacral anomaly (0.56 ± 0.19 vs 0.7 ± 0.16, p= 0.0009). SR were significantly different in subgroups based on ARM subtypes and presence or absence of spinal and sacral anomaly (p=0.0189).

Conclusion: SR measured on x-ray may suggest associated spinal or sacral anomaly. SR may be used to identify patients who would benefit from an MRI. Larger studies are required to establish a cut-off value of SR for normal anatomy of spinal cord and sacrum.

Keywords: anorectal malformation, spinal malformation, sacral malformation, imaging, sacral ratio

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