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Occult spinal dysraphisms in newborns with skin markers: role of ultrasonography and magnetic resonance imaging

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Abstract

Purpose

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.

Method

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Spina Bifida Center, Women’s and Infant Health Sciences, A. Gemelli Policlinic, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy

    E. Ausili, G. Maresca, L. Morgante, C. Romagnoli & C. Rendeli

  2. Neurosurgery Department, Catholic University of Sacred Heart, Largo A. Gemelli 8, 00168, Rome, Italy

    L. Massimi

Authors
  1. E. Ausili
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  2. G. Maresca
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  3. L. Massimi
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  4. L. Morgante
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  5. C. Romagnoli
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  6. C. Rendeli
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Corresponding author

Correspondence to E. Ausili.

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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Ausili, E., Maresca, G., Massimi, L. et al. Occult spinal dysraphisms in newborns with skin markers: role of ultrasonography and magnetic resonance imaging. Childs Nerv Syst 34, 285–291 (2018). https://doi.org/10.1007/s00381-017-3638-0

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  • DOI: https://doi.org/10.1007/s00381-017-3638-0

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