Spinal Sonography in Infants with Cutaneous birth Markers in the Lumbo-Sacral Region – an Important Sign of Occult Spinal Dysrhaphism and Tethered Cord

Abstract

Cutaneous markers in the lumbo-sacral region are indicators of occult spinal dysrhaphism and tethered cord. By means of spinal sonography, anatomical abnormalities of the spinal cord can be shown in the neonatal period. We report on 6 infants with lumbo-sacral cutaneous abnormalities who were investigated with a high resolution linear transducer (> 7.5 MHz) and a computer sonographic unit (Sequoia, Acuson). The investigations were performed between the first day of life and the ninth week (m: 26 days). The following cutaneous markers could be found: Asymmetrical gluteal crease (4); dermal sinus (2), hairy tuft (1); pigmented naevus (1); cutaneous appendage (1); haemangioma (1); unilateral peroneal paralysis with hypotrophic correspondic leg (1). Sonographic evaluation showed the following abnormalities: Tethered cord (6); diastematomyelia (2); tight filum terminale (2); spinal lipoma (3); lipomyelomeningocele (2), myelocystocele and hydromyelia (1). In all infants, sonographic diagnosis could be confirmed by MR imaging and intraoperatively. Surgical correction was performed at the age of 2 to 12 months (m: 7.7 months). All infants with cutaneous markers in the lumbo-sacral region should be investigated by spinal sonography as long as the vertebral arches are not completely ossified. Sonography of the spinal cord may detect occult spinal dysrhaphism and tethered cord and prevent neurological damage by early surgical correction at the end of the first year of life.