Use of lumbar ultrasonography to detect occult spinal dysraphism

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>Various cutaneous stigmata and congenital anomalies are accepted as sufficient reasons to perform lumbar ultrasonography as a screening tool to rule out occult spinal dysraphism (OSD). The purpose of this study was to correlate presenting cutaneous findings with lumbar ultrasonography results based on a large number of lumbar ultrasonography tests obtained by regional primary care providers.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Over the course of 5 years, 1273 infants underwent lumbar ultrasonography screening at a major pediatric tertiary referral center. Of these infants, 1116 had adequate documentation for retrospective chart review. Referral sources included urban academic, urban private practice, and surrounding rural private practitioners. Presence of cutaneous stigmata and/or congenital anomalies and lumbar ultrasonography results were reviewed for all patients. When present, surgical findings were reviewed.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>A total of 943 infants were referred for presumed cutaneous stigmata, the most common of which was a sacral dimple (638 patients [68%]) followed by hairy patch (96 patients [10%]). Other reported cutaneous findings included hemangioma, deviated gluteal fold, skin tag, and skin discoloration. In comparison, 173 patients presented with congenital anomalies, such as imperforate anus (56 patients [32%]) and tracheoesophageal fistula/esophageal atresia (37 patients [21%]), most of which were detected prenatally by fetal ultrasonography. A total of 17 infants underwent surgical exploration. Occult spinal dysraphism was diagnosed in 7 infants in the cutaneous stigmata group and in 10 infants in the group with congenital abnormalities. None of the cutaneous stigmata as recorded were found to be indicative of the presence of OSD.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Cutaneous markers as currently defined by general practitioners are not useful markers for predicting OSD. The vast majority of findings on lumbar ultrasonography studies performed under these circumstances will be negative.</jats:p></jats:sec>

Spine ultrasounds should not be routinely performed for patients with simple sacral dimples

“…The remaining nine papers addressed the routine use of spine ultrasound in patients with sacral dimples and, or, other cutaneous stigmata. All nine papers provided sufficient detail to allow abstraction of data related to simple sacral dimples (Fig. ).…”

“…In three studies, these findings included isolated low conus medullaris, fatty filum terminale, decreased motion of the conus medullaris, spina bifida occulta or a combination of these findings . In the fourth study, findings considered abnormal on ultrasound were defined, but it was not possible to abstract the findings specific to simple sacral dimples, apart from the findings in patients with other cutaneous markers, such as hypertrichosis and haemangiomas .…”

Retethering in Children after Sectioning of the Filum Terminale

“…There are centers that perform untethering in asymptomatic patients with the hope of preventing symptoms in the future [12]. This process gets initiated when asymptomatic infants are sent for radiological imaging by their family physician or pediatrician when a sacral dimple is identified.…”

“…Those who are asymptomatic are usually identified by family physicians or pediatricians who find a sacral dimple, which is then further investigated with radiological imaging [12]. This usually begins with a spine ultrasound if the patient is less than 8 months of age and/or a spine MRI [13], which usually requires a general anesthetic.…”

"Tethered Cord Syndrome - A Rare Case Report"

“…Cutaneous discrepancies include midline hairy patches, hemangiomas, dermal pits/sinuses, hypertrichosis, subcutaneous lipoma, "cigarette burns," lumbosacral appendage, and nevi. While the appearance of any of the aforementioned findings is sufficient to warrant investigation, recent work spanning 12 years of pediatric patients suggests that an isolated sacral dimple in an otherwise asymptomatic child has a significantly low association with tethered cord syndrome; the incidence of necessary surgical de-tethering in that population ranged from only 0.13 to 0.17% [18][19][20] . That being said, ultrasound is simpler to perform and easier to obtain than an Magnetic Resonance Imaging at a later point when the child may already have become symptomatic and will also require sedation.…”