Occult spinal dysraphisms in newborns with skin markers: role of ultrasonography and magnetic resonance imaging
- 563 Downloads
The purpose of this paper is to investigate occult spinal dysraphisms (OSD) using lumbar ultrasonography (LUS) in newborns presenting with specific skin markers or sacrococcygeal dimple.
From 2012 to 2015, we performed LUS in newborns with cutaneous stigmata and/or sacroccygeal dimple. Magnetic resonance imaging (MRI) was performed in all patients with abnormal ultrasound or features of neurological involvement in order to detect spinal lesions.
We prospectively evaluated 475 newborns who presented cutaneous stigmata performing LUS during their 4 weeks of life though 439 completed the study. All patients had a follow-up of almost 12 months. Of these, 39 presented abnormal ultrasonography and underwent MRI. In this group, spinal dysraphism was confirmed in 12 patients. When considering skin markers, dermal sinus correlated with higher risk of spinal cord lesions, on the other hand the presence of simple sacral dimple alone denoted a very low risk of occult spinal dysraphism. The simultaneous presence of more skin markers and/or the presence of lumbar ultrasonography abnormality regarding the level of the conus, pulsatility, and the position of the cord, thickness of the filum terminale, or the presence of an intratecal mass, lipoma, or dermal sinus tract indicated the necessity to perform MRI in order to detect spinal cord abnormalities because of higher risk of spinal lesions.
LUS in newborns with specific skin markers is a valid method to select patients in which MRI can be performed to detect OSD. The presence of a simple sacral dimple alone is a negligible marker for occult neural pathology while the presence of isolated dermal sinus or more than one cutaneous marker could be considered indicative of higher risk of spinal dysraphism.
KeywordsOccult Dimple Ultrasound Dermal sinus Lipoma
Compliance with ethical standards
Conflict of interest
The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
- 3.Ben-Sira L, Ponger P, Miller E, Beni-Adani L, Constantini S (2009) Low-risk lumbar skin stigmata in infants: the role of ultrasound screening. J Pediatr 155(864–869):2Google Scholar
- 14.Inchingolo R, Maresca G, Cacaci S, Ausili E, Paolucci V, Bonomo L, Romagnoli C, Rendeli C (2013 Aug) Post-natal ultrasound morpho-dynamic evaluation of mild fetal hydronephrosis: a new management. Eur Rev Med Pharmacol Sci 17(16):2232–2239Google Scholar
- 16.Fitzgerald K (2011) Ultrasound examination of neonatal Spine. Autralas J Ultrasound Med 14(1):39–41Google Scholar
- 19.Hughes JA, De Bruyn R, Patel K, Thompson D (2003) Evaluation of spinal ultrasound in spinal dysraphism. Clin Radiol 58(227–233):5Google Scholar
- 22.Dick EA, de Bruyn R (2003) Ultrasound of the spinal cord in children: its role. Eur Radiol 13:552–562Google Scholar
- 28.Valentini LG, Selvaggio G, Erbetta A, Cordella R (2013) Occult spinal dysraphism: lessons learned by retrospective analysis of 149 surgical cases about natural history, surgical indications, urodynamic testing, and intraoperative neurophysiological monitoring. Childs Nerv Syst 29:1657–1669CrossRefGoogle Scholar