Objective: To determine the prevalence of associated vertebral anomalies in patients with Anorectal Malformations in LASUTH and assess the prognostic value of Sacral ratios. Methodology: A prospective study of 44 old and new patients who presented with Anorectal Malformations to the Paediatric Surgery unit in Lagos State University Teaching Hospital over a 15month duration. They were thoroughly examined with particular attention paid to the perineum and subsequently had plain lumbosacral radiographs done. Their biodata, type of anomaly and the presence of associated anomalies were noted. Various surgical treatment modalities were offered depending on the type of anomaly and mode of presentation. Complications and outcome within the study period were also recorded. Their Sacral ratios were calculated from the lumbosacral radiographs, interpreted as normal or abnormal based on Pena’s criteria and correlated to the outcome. Results: Of the 44 patients seen, 21(47.7%) were male and 23(52.3%) female. 17(38.6%) had intermediate anomalies, 14(31.8%) low and 13(29.5%) high anomalies. Vertebral anomalies were found to be the most predominant associated anomalies, occurring in 10 patients (22.7%). Other associations found were Renal/urogenital in 7 patients (15.9%), Cardiac in 4 patients (9.1%) and Limb anomalies in one patient (2.3%). The mean Antero-posterior Sacral Ratio (APSR) + SD was 0.70 + 0.78 while the mean Lateral Sacral Ratio (LSR) + SD was 0.76 + 0.71. A large proportion (Twenty-nine, 80.6%) of the patients assessed for continence had a good outcome, while seven patients (19.4%) had soiling of their underwear. Conclusion: Sacral ratios do not have a significant effect on conclusively predicting outcome of management in patients with Anorectal Malformations