Spinal sonography in term neonates with cutaneous markers of occult spinal dysraphism: Results of our experience

Abstract

Occult spinal dysraphism (OSD) refers to skin-covered lesions, characterized by incomplete fusion of the midline mesenchymal, bony or neural elements of the spine. 3–8% of the infants with cutaneous markers in the lumbo-sacral region have an underlying OSD. We report the occurrence of OSD in neonates with congenital midline lumbosacral cutaneous markers. Over a 3 year period, 240 neonates (125 m/115 f) were scanned between the first day of life and the ninth week (m: 54 days) with a high resolution linear transducer (7.5 MHz). Data collected included: indication for ultrasound examination (US), date of birth, date of US, age at US, findings of antenatal US and other findings where relevant. Abnormalities had already been detected antenatally in two cases. In 10/240 examined neonates (4.1%) we observed: spinal lipoma (n° 3) lipomyelomeningocele (n° 2), lipomyelocele (n° 1), meningocele (n° 1) lumbar dermoid cyst (n° 2), and hydromelia (n° 1). In 6/10 newborns (60%) with OSD there was a combination of two or more different skin lesions. In all infants, it was confirmed by MRI imaging. Surgical correction was performed at the end of the first year of life (m: 5 m). MRI is the gold standard of screening for OSD, but it is time consuming, costly and invasive. US revealed an effective, non invasive, inexpensive screening method, useful to detect OSD as long as the vertebral arch region is not completely ossified. A combination of 2 or more congenital midline skin lesions constitutes the strongest marker of OSD.