Pediatric Spinal Ultrasound: Neonatal and Intraoperative Applications

The AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Neonatal and Infant Spine

“…The technique for these studies is beyond the scope of this practice parameter but is described in the literature. These indications include, but are not limited to, intraoperative guidance for tumor resection, decompression of Chiari I malformation, and catheter placement for neuraxial analgesia, 15,16 neurostimulator device placement and monitoring its positioning, and assessment of lengthening of magnetically controlled growing spinal rods. 17 Sacral dimples associated with a high risk of occult spinal dysraphism include those in which the base of the dimple is not seen, are located >2.5 cm above the anus, or are seen in combination with other cutaneous abnormalities.…”

Ultrasound to Evaluate Neonatal Spinal Dysraphism: A First‐Line Alternative to CT and MRI

“…The main indications for neonatal spinal US are examining infants with cutaneous stigmata overlying the spinal column, complicated (high lying [>2.5 cm superior to the anus]) sacral dimples, midline, or paramedian soft tissue mass (e.g., skin covered dysraphism, lipomas, teratomas, and skin tags) or congenital anomalies (e.g. non‐skin covered myelomeningocele, focal scoliosis) . Closed spinal dysraphism is usually less apparent at birth and commonly brought to attention by the presence of abnormalities in the overlying skin (such as an abnormal tuft of hair, pigmentation, hemangioma, a sinus opening, or a mass) .…”

“…The infant should be well‐fed and warm gel should be used to reduce fussiness. The examination should be performed in real‐time using high‐frequency linear probes, typically ranging from 7 to 12 MHz or higher (Fig A,B) . Both sagittal (Fig A) and axial (Fig B) planes should be included in the scanning protocol.…”

“…non-skin covered myelomeningocele, focal scoliosis). [8][9][10] Closed spinal dysraphism is usually less apparent is mandatory for an informative spinal ultrasound study. The examination is usually performed with the infant (phantom in A,B) lying in the prone position, a small bolster or towel may be placed under the lower abdomen/pelvis to mildly flex the back, which may improve imaging.…”

“…The examination should be performed in real-time using high-frequency linear probes, typically ranging from 7 to 12 MHz or higher ( Fig 1A,B). 7,8,10,12 Both sagittal (Fig 2A) and axial ( Fig 2B) planes should be included in the scanning protocol. Additional oblique views may be possible and/or necessary, especially in complex malformations.…”