Spinal Sonography in Infants with Cutaneous birth Markers in the Lumbo-Sacral Region – an Important Sign of Occult Spinal Dysrhaphism and Tethered Cord

Zusammenfassung

Ziel: Kutane Stigmata im lumbosakralen Bereich können Hinweise auf okkulte spinale Dysrhaphien sein. Mit der spinalen Sonografie können anatomische Auffälligkeiten des Rückenmarks in der Neonatalperiode erkannt werden. Patienten: Wir berichten über 6 Säuglinge mit kutanen lumbosakralen Auffälligkeiten, die mit einem hochauflösenden Linearschallkopf (> 7,5 MHz) zwischen dem 1. Lebenstag und der 9. Woche (m: 26 Tage) untersucht wurden. Bei den Kindern bestanden folgende kutane Auffälligkeiten: asymmetrische rima ani (4); lumbale Weichteilschwellung (2); Dermalsinus (2); Haarnaevus (1); Pigmentnävus (1); häutiges Hautanhängsel (1); Hämangiom (1) sowie einseitige Peroneuslähmung mit trophischer Störung der unteren Exremität. Ergebnisse: Folgende Diagnosen wurden gestellt: tethered cord (6); Diastematomyelie (2); tight filum terminale (2); spinales Lipom (3); Lipomyelomeningocele (2); Myelocystocele und Hydromyelie (1). Bei allen Kindern konnte die sonografische Diagnose kernspintomografisch und bei der operativen Korrektur im Alter von 2 bis 12 Monaten (m: 7,7 Monate) bestätigt werden. Schlussfolgerung: Bei allen Kindern mit kutanen lumbosakralen Auffälligkeiten sollte das Rückenmark in der Neonatalperiode untersucht werden, um okkulte spinale Dysrhaphien und ein tethered cord frühzeitig zu diagnostizieren und die operative Korrektur vor Einsetzen neurologischer Störung gegen Ende des 1. Lebensjahres durchführen zu können.

Abstract

Aim: Cutaneous markers in the lumbo-sacral region are indicators of occult spinal dysrhaphism and tethered cord. By means of spinal sonography, anatomical abnormalities of the spinal cord can be shown in the neonatal period. Patients: We report on 6 infants with lumbo-sacral cutaneous abnormalities who were investigated with a high resolution linear transducer (> 7.5 MHz) and a computer sonographic unit (Sequoia, Acuson). The investigations were performed between the first day of life and the ninth week (m: 26 days). The following cutaneous markers could be found: Asymmetrical gluteal crease (4); dermal sinus (2), hairy tuft (1); pigmented naevus (1); cutaneous appendage (1); haemangioma (1); unilateral peroneal paralysis with hypotrophic correspondic leg (1). Results: Sonographic evaluation showed the following abnormalities: Tethered cord (6); diastematomyelia (2); tight filum terminale (2); spinal lipoma (3); lipomyelomeningocele (2), myelocystocele and hydromyelia (1). In all infants, sonographic diagnosis could be confirmed by MR imaging and intraoperatively. Surgical correction was performed at the age of 2 to 12 months (m: 7.7 months). Conclusion: All infants with cutaneous markers in the lumbo-sacral region should be investigated by spinal sonography as long as the vertebral arches are not completely ossified. Sonography of the spinal cord may detect occult spinal dysrhaphism and tethered cord and prevent neurological damage by early surgical correction at the end of the first year of life.

Key words

spine - occult spinal dysrhaphism - tethered cord - diastematomyelia - lipomyelomeningocele - myelocystocele - cutaneous birth markers

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