Minor skin lesions as markers of occult spinal dysraphisms—prospective study

Abstract

Background Neonates with occult spinal dysraphisms (OSDs) may not present any clinical manifestations, but may be associated to cutaneous stigmas that indicate dysraphism. Association of minor cutaneous stigmas (discreet skin lesions, most of which are not assessed) with OSD was investigated in this study, as well as the use of ultrasonography (US) as a screening method for those patients. Methods Two thousand ten neonates were evaluated trough active search. Both the pediatrician and the neurosurgeon performed the search for the presence of cutaneous stigmas on the midline of the dorsal region. For all of them, the gestational age, type of delivery, gender, ethnicity, age of mother, and whether it was a high-risk gestation were recorded. Patients with skin lesions comprised the case group. For each case, another neonate of the same gender, gestational age, and ethnicity was selected as control. Both groups were evaluated with respect to personal, social, and medical information. Spinal US was performed in all case and control patients—if altered or inconclusive, it was complemented with magnetic resonance imaging (MRI). Results Of the 2010 patients, 144 presented cutaneous stigmas. Of these, 8 had alterations to US (5.5%) and 6 to MRI. There were no alterations to US in the control group. The most frequent lesions were tufts of hair and dimples; through US, the most frequent findings were dermal sinuses. Conclusions The so-called minor skin lesions were not markers of OSD in the evaluated population. However, in 4 patients, US was decisive for the surgical decision. From the statistical point of view, there is no indication for complementary examinations in patients with minor cutaneous stigmas. However, because of the feasibility, simplicity, and low cost of the spinal US, the examination is justified in the benefits of early diagnosis, regardless of the need of immediate surgical treatment.