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PubMed This is a summary of 19 peer-reviewed journal articles Updated
Orthopedics

How CRS Affects Your Child's Body

At a Glance

Caudal Regression Syndrome (CRS) is a multisystem condition affecting a child's lower body development. It primarily impacts orthopedic stability, neurological function, and urological health. Coordinated medical care is essential to protect kidney function and support mobility.

Because Caudal Regression Syndrome (CRS) affects the development of the lower body, it is known as a multisystem condition—meaning it can impact several different parts of the body at once [1][2]. While every child’s experience is unique, understanding the typical areas involved can help you partner with your medical team to provide the best possible care.

Orthopedic Impact: Stability and Movement

The most visible effects of CRS are often related to the bones and joints. Because the lower spine may be partially or completely missing (sacral/lumbar agenesis), the foundation of the body is different [3][4].

  • Spinopelvic Dissociation: In some cases, the upper spine is not fully connected to the pelvis, which can affect a child’s ability to sit or stand upright [5][6].
  • Hip Dysplasia: The hips may be unstable or out of their sockets (dislocated) because the surrounding muscles and bones did not develop typically [7].
  • Kyphotic Deformity: This is a forward rounding or “hump” in the back that can happen when vertebrae are missing, affecting balance and comfort [4][6].

Neurological Impact: The Message Center

The spinal cord is the “cable” that sends messages between the brain and the body. In CRS, the spinal cord may end abruptly or be unusually shaped [8][9].

  • Motor and Sensory Deficits: Depending on where the spinal cord ends, a child may have reduced movement or feeling in their legs and feet [8][10].
  • Tethered Cord: Sometimes the spinal cord is “stuck” to the surrounding tissues instead of floating freely. As a child grows, this can stretch the cord, potentially causing new pain or changes in how they move or use the bathroom [11][12].

Urological and Gastrointestinal Health

The nerves that control the bladder and bowels are located at the very bottom of the spine. Even if a child has good movement in their legs, these internal systems may still need support [13][14].

  • Neurogenic Bladder: This means the bladder doesn’t send or receive signals correctly, which can lead to difficulty emptying or unexpected leaking. Careful monitoring is essential to protect the kidneys from pressure or infection [14][15].
  • Gastrointestinal Issues: Some children are born with an imperforate anus (where the opening is missing or blocked) or experience fecal incontinence (difficulty controlling bowel movements) [2][16].

The VACTERL Connection

Doctors often look for a pattern of other health features called the VACTERL association [17][2]. While CRS and VACTERL are separate diagnoses, they can overlap. VACTERL stands for:

  • V: Vertebral (spine)
  • A: Anal (anorectal)
  • C: Cardiac (heart)
  • TE: Tracheo-Esophageal (windpipe/feeding tube)
  • R: Renal (kidney)
  • L: Limb (arms/legs)

Your doctor may order an echocardiogram (heart ultrasound) or other tests to ensure every system is working as well as possible [17][18]. It is also important to note that while the “R” stands for Renal (kidney) structural defects, kidney problems in children with CRS are frequently caused by dangerous “back-pressure” from a neurogenic bladder rather than just a primary congenital structural defect [14]. This makes regular urological check-ups absolutely crucial.

Looking Ahead: Growth and Change

As your child moves from infancy into childhood, their needs will shift. Early on, the focus is often on identifying structural issues and protecting kidney function [8][19]. As they grow, the focus moves toward mobility (using braces, walkers, or wheelchairs) and independence in managing bladder and bowel care [14][7]. Regular check-ups with your multidisciplinary team ensure that any changes, such as spinal growth or a tethered cord, are addressed early.

Common questions in this guide

How does Caudal Regression Syndrome affect a child's legs and mobility?
CRS can impact the bones, joints, and nerves in the lower body. This may cause hip dysplasia, poor spinal connection to the pelvis, or reduced feeling and movement in the legs, which can influence whether a child uses braces, a walker, or a wheelchair.
What is a tethered spinal cord in children with CRS?
A tethered cord happens when the spinal cord gets stuck to surrounding tissues instead of floating freely in the spinal canal. As your child grows, this can stretch the cord and potentially cause new pain, changes in how they walk, or new bathroom accidents.
Why do children with CRS need to be monitored for kidney health?
The nerves that control the bladder are located at the bottom of the spine, which is often underdeveloped in CRS. This can cause a neurogenic bladder that doesn't empty properly, leading to dangerous back-pressure or infections that can permanently damage the kidneys.
What is the VACTERL association and how does it relate to CRS?
VACTERL is an acronym for a pattern of structural differences affecting the spine, anus, heart, windpipe, kidneys, and limbs. While separate from a CRS diagnosis, the two can overlap, so doctors routinely screen children with CRS for these additional features.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.How would you classify my child's CRS based on the level of vertebrae involved?
  2. 2.Can you explain the results of the baseline urodynamic study and what they mean for my child's kidney health?
  3. 3.What are the specific signs of a tethered spinal cord that I should look for as my child grows?
  4. 4.Has my child been screened for all components of the VACTERL association, including a heart ultrasound?
  5. 5.What is the long-term plan for monitoring my child's hip stability and spinal alignment?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (19)
  1. 1

    Clinical and radiological evaluation of caudal regression syndrome.

    Krishnan V, Jaganathan S, Jayappa S, et al.

    Pediatric radiology 2024; (54(9)):1451-1461 doi:10.1007/s00247-024-05945-1.

    PMID: 38750326
  2. 2

    Caudal Regression Syndrome (Spinal Thoraco-lumbo-sacro-coccygeal Agenesis).

    Akhaddar A

    World neurosurgery 2020; (142()):301-302 doi:10.1016/j.wneu.2020.07.055.

    PMID: 32683002
  3. 3

    Caudal Regression Syndrome: A Case Series of a Rare Congenital Anomaly.

    Kumar Y, Gupta N, Hooda K, et al.

    Polish journal of radiology 2017; (82()):188-192 doi:10.12659/PJR.900971.

    PMID: 28439323
  4. 4

    Atypical caudal regression syndrome with agenesis of lumbar spine and presence of sacrum - case report and literature review.

    Szumera E, Jasiewicz B, Potaczek T

    The journal of spinal cord medicine 2018; (41(4)):496-500 doi:10.1080/10790268.2017.1369211.

    PMID: 28875772
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    Sacral agenesis combined with spinopelvic dissociation: A case report and literature review.

    Zhang H, Guo H, He S, et al.

    Medicine 2018; (97(37)):e12162 doi:10.1097/MD.0000000000012162.

    PMID: 30212942
  6. 6

    Surgical Correction of Spinopelvic Instability in Children With Caudal Regression Syndrome.

    Vissarionov S, Schroder JE, Kokushin D, et al.

    Global spine journal 2019; (9(3)):260-265 doi:10.1177/2192568218779984.

    PMID: 31192092
  7. 7

    Clinical and Radiological Characterization of an Infant with Caudal Regression Syndrome Type III.

    Dayasiri K, Thadchanamoorthy V, Thudugala K, et al.

    Case reports in neurological medicine 2020; (2020()):8827281 doi:10.1155/2020/8827281.

    PMID: 33194235
  8. 8

    Think of the Conus Medullaris at the Time of Diagnosis of Fetal Sacral Agenesis.

    Mottet N, Martinovic J, Baeza C, et al.

    Fetal diagnosis and therapy 2017; (42(2)):137-143 doi:10.1159/000451080.

    PMID: 27794580
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    A Rare Case of Caudal Regression Syndrome in a Foetus of Non-Diabetic Mother: A Case Report.

    Chawla GS, Agrawal PM, Bajwa KS

    Polish journal of radiology 2017; (82()):621-624 doi:10.12659/PJR.903275.

    PMID: 29657626
  10. 10

    Sacral Agenesis Type II in a 12-Year-Old Patient: A Delayed Presentation in a Low-Resource Setting.

    Ayub M, La QD, Baloch A, Ahmed S

    Cureus 2025; (17(6)):e86903 doi:10.7759/cureus.86903.

    PMID: 40726883
  11. 11

    Aberrant Dorsal Nerve Root as a Concomitant Cause of Spinal Cord Tethering Associated with a Dorsal Type Lipomyelomeningocele in a Child With Caudal Agenesis.

    Baskurt O, Hicdonmez T, Gazioglu MN

    Nigerian journal of clinical practice 2024; (27(4)):537-540 doi:10.4103/njcp.njcp_838_23.

    PMID: 38679779
  12. 12

    Radiological and clinical aspect of Caudal regression syndrome associated with dorsal hemivertebra without maternal diabetes.

    Kadri H, Dughly M, Agha MS, et al.

    Radiology case reports 2024; (19(8)):3548-3551 doi:10.1016/j.radcr.2024.05.002.

    PMID: 38948903
  13. 13

    Caudal regression syndrome with diplomyelia (type 2 split cord malformation), tethered cord, syringomyelia, and horse-shoe kidney.

    Demir MK, Toktaş ZO, Yılmaz B, et al.

    The spine journal : official journal of the North American Spine Society 2016; (16(3)):e193-4.

    PMID: 26482981
  14. 14

    Continence management in children with severe caudal regression syndrome: role of multidisciplinary team and long-term follow-up.

    Esposito G, Totonelli G, Iacobelli BD, et al.

    Pediatric surgery international 2022; (38(10)):1461-1472 doi:10.1007/s00383-022-05168-1.

    PMID: 35943565
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    Pregnancy in a patient with caudal regression syndrome following continent bladder reconstruction.

    Shigenobu Y, Nagayama S, Manaka Y, et al.

    The journal of obstetrics and gynaecology research 2022; (48(10)):2615-2619 doi:10.1111/jog.15334.

    PMID: 35778981
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    Sirenomelia: a rare presentation.

    Reddy KR, Srinivas S, Kumar S, et al.

    Journal of neonatal surgery 2012; (1(1)):7.

    PMID: 26023366
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    Severe caudal regression syndrome with overlapping features of VACTERL complex: antenatal detection and follow up.

    Kanagasabai K, Bhat V, Pramod GK, et al.

    BJR case reports 2017; (3(2)):20150356 doi:10.1259/bjrcr.20150356.

    PMID: 30363289
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    Caudal Regression Syndrome - a rare congenital disorder: A case report.

    Mehdi SM, Baig U, Zia MH, Iftikhar N

    JPMA. The Journal of the Pakistan Medical Association 2021; (71(12)):2847-2849 doi:10.47391/JPMA.01-499.

    PMID: 35150560
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    How to Explore Fetal Sacral Agenesis Without Open Dysraphism: Key Prenatal Imaging and Clinical Implications.

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    PMID: 29377253

This page explains the physical effects of Caudal Regression Syndrome for educational purposes only. Always consult your child's multidisciplinary medical team for personalized advice, monitoring, and treatment planning.

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