Congenital Limb Duplication and Spinal Dysraphism: A Rare Case Report Highlighting Single-Stage Multidisciplinary Surgery and Life-Changing Outcome.

BACKGROUND Congenital polymelia, defined as the presence of supernumerary limbs, is an exceedingly rare anomaly with an estimated incidence of less than 1 per million live births. Its coexistence with spinal dysraphism creates a complex clinical picture requiring intricate diagnostic workup and surgical planning. The purpose of this case report is to contribute to the existing literature on limb duplication. CASE REPORT A 19-month-old girl presented with an additional limb and the inability to walk independently. Physical examination revealed a "tail-like" appendage with features resembling a flexed thigh and foot. She was subsequently diagnosed with congenital lumbosacral limb duplication associated with spinal dysraphism. Computed tomography-angiography revealed that the duplicated limb was supplied by a branch of the distal branch of the left common iliac artery. MRI of the lumbosacral vertebrae and spinal cord also indicated the presence of lipomyelocele. A coordinated single-stage surgery was performed, involving orthopedics, neurosurgery, and plastic surgery. Resection of spinal dysraphism was the initial step in this single-staged multidisciplinary surgery. This was followed by ablation of the accessory limb and defect closure. The surgery was a success, and the patient experienced an uneventful recovery, being discharged on the seventh postoperative day. At the 6-month follow-up, she achieved independent ambulation. CONCLUSIONS This case underscores that despite the rarity and complexity of polymelia with spinal dysraphism, a planned single-stage resection is safe and effective, leading to life-changing functional outcomes.