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Asymptomatic spina bifida occulta involving sacrum in an elderly female

Figure 1 Posterior view of the sacrum shows a dry bone specimen of sacral spina bifida occulta, where there is failure of closure of the sacral canal at all sacral levels A 60 year female presented with low back pain of two year duration, non-radiating in nature but increased by bending forward. There was no history of bowel or bladder disturbances. She had swelling over low back region since childhood not associated with pain. Her general and systemic examination was normal. There was diffuse, non-tender, non-pulsatile swelling over sacral region. Skin over the swelling was healthy. Plain lumbosacral x-ray demonstrated a sacral bone defect. Pelvic computed tomography (CT) showed a defect at the dorsal aspect of the sacrum with diffuse soft tissue swelling (Figure 1). Patient responded to conservative management and physiotherapy. There are many reports on the incidence of sacral spina bifida occulta and it has been suggested that 90-100% of patients with a sacral level lesion are ambulant. (1, 6-10) The reported clinical significance of sacral spina bifida occulta ranges from an anatomical variant of little or no importance on its own to a very important cause of meningomyelocele or neurological deficits. (1, 6, 10-17) In absence of external manifestations occult spina bifida of the sacrum can be associated with a number of