A patient with known total sacral agenesis was referred for an MRI of the lumbar spine and pelvis to rule out further anomalies prior to urologic treatment of urinary incontinence. Apart from slight contractures of the knee joints, she could sit, stand and and walk normally.
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MRI showed total absence of the sacrum and a fifth lumbar vertebra, that articulated directly with the iliac bones, forming broad bilateral synchondroses (Renshaw type III). At the articulations on both sides, there were subchondral marrow signal changes (Modic type I/II). The conus medullaris showed a normal location at L1.