The Role of Ultrasound Investigation: Sacral Dimples and Other Stigmata of Spinal Dysraphism in Infants

Jung Yun Bae; Yong-Woo Kim; Sang Min Lee; Kuen Tak Suh

doi:10.4184/jkss.2015.22.1.8

Journal List > J Korean Soc Spine Surg > v.22(1) > 1076082

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Bae, Kim, Lee, and Suh: The Role of Ultrasound Investigation: Sacral Dimples and Other Stigmata of Spinal Dysraphism in Infants

Original Article

Journal of Korean Spine Surg 2015;22(1):8-12.

Published online: 21 March 2015

DOI: https://doi.org/10.4184/jkss.2015.22.1.8

The Role of Ultrasound Investigation: Sacral Dimples and Other Stigmata of Spinal Dysraphism in Infants

Jung Yun Bae, M.D., Yong-Woo Kim, M.D.^∗, Sang Min Lee, M.D., Kuen Tak Suh, M.D.

Department Orthopaedic Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea

^∗Department Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea

Corresponding author: Jung Yun Bae, M.D. Department of Orthopaedic Surgery, Pusan National University School of Medicine Beomeo-ri, Mulgeum-eup, Yangsan city, Gyeongsangnam-do 626-700, Korea

Received 14 July 2014 Revised 2 October 2014 Accepted 20 November 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective study.

Objectives

Using ultrasound to evaluate association of minor cutaneous stigmas with occult spinal dysraphism (OSD) according to the presence of co-morbidities.

Summary of Literature Review

OSD can be associated with various cutaneous markers. Ultrasound of the spine is an effective, non-invasive screening method.

Materials and Methods

Over a 5-year period (2009-2013), a total of 180 infants with various skin stigmas were evaluated. Ninety- seven patients were normal infants, eighty-three had other co-morbidities. The type of skin stigmata and/or co-morbidities as well as lumbar ultrasound results were reviewed for all patients.

Results

Three of the 97 normal infants had abnormalities. One of the three had OSD. Eighteen of the 83 infants with congenital anomalies had abnormalities, and eleven of the 18 had OSD. Infants with congenital anomalies were 6 times more likely to have OSD than normal infants (OR 5.98, 95% CI 1.927 to 18.612, p=0.001) and there was no significant correlation between the presence of minor skin lesions and the presence of dysraphism.

Conclusions

So-called minor skin lesions were not markers of OSD in normal infants. However, because of the feasibility, simplicity, and low cost of spinal ultrasound, the examination is justified by the benefits of early diagnosis.

Keywords: Occult spinal dysraphism, Skin stigma, Ultrasound

REFERENCES

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Figures and Tables%

Fig. 1.

Clinical features of lumbosacral skin stigmas. (A) Dimple; (B) Midline deviation, (C) Mass, (D) Dimple + hair.

Fig. 2.

Summary of patients referred for lumbar ultrasonography because of the presence of congenital abnormalities.

Fig. 3.

Newborns with combined sacral cutaneous lesions. (A) Clinical characteristics of a sacral dimple with hair. (B) A sonogram showing a longitudinal view of a lipoma. (C) A sonogram showing a longitudinal view of a tethered cord.

Table 1.

Summary of patients referred for lumbar ultrasonography because of the presence of cutaneous markers

	Parameters	Skin stigma only (N=97)	Skin stigma-associated congenital abnormality (N=83)	No. cases	p-value
Gender	Male	33	45	78	0.131
Gender	Female	64	38	102	0.131
Age (days)		42.97±57.48	35.02±25.25		0.006
Type	Dimple	81	75	158	0.236
	Midline deviation	3	0	3
	Mass	7	3	2
	Dimple+hair	6	3	8
	Dimple+midline deviation	1	0	9
Detected Abnormality	Low lying conus medullaris	0	9	9	0.001
	Cystic mass in spinal canal	1	3	4
	Tethered cord	1	3	4
	Dermal sinus	1	1	2
	Spina bifida	0	1	1
	Dermal sinus+intradural mass	0	1	1

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