Background: Spinal dysraphism (SD) is a spectrum of congenital disorders. MRI is the gold standard technique for diagnosis of SD. Spinal ultrasonography (USG) can be used as a screening tool for SD in infants. The purpose of our study is to assess the diagnostic value of spinal USG in the diagnosis of spinal dysraphism in pediatrics compared to MRI as a gold standard technique. Our prospective, cross-sectional study involved 45 infants and children with suspected spinal dysraphism. All patients were subjected to supervision of their medical history, full neurological examination, spinal ultrasonography and anatomical spine assessment by conventional MRI examination including sagittal and axial T1W & T2W, sagittal & coronal STIR imaging. Comparison of spinal USG with MRI findings was done. Results: There is excellent overall agreement between MRI and ultrasound diagnosis in the evaluation of spinal cord morphology and bony elements in patients aged ≤ 2 years old (κ = 0.96 and 0.98) respectively, and fair overall agreement between MRI and ultrasound diagnosis (κ = 0.58) in patients aged > 2 years old. The accuracy of spinal USG in diagnosis of spinal dysraphism in patients aged ≤ 2 years old was as the following: specificity (94.5-100%), sensitivity (84.3100%), PPV (86.7-100%) and NPV (85.7-100%), as compared to MRI. Conclusion: Spinal ultrasound can be used as a first-line screening investigation for SD; patients with USG abnormalities proceed to MRI. Spinal ultrasound is of no worthy value after the age of bone ossification, and MRI is the best modality of diagnosis in older pediatrics.