Abstract
Objective Ultrasound (US) is a common imaging modality used to evaluate spinal anomalies in
newborns. However, many indications for the use of spinal US are associated with low
diagnostic yield. The purpose of this study is to evaluate the indications and the
diagnostic utility of spinal USs performed in newborns at our institution. We also
review patient presentations for caudal regression syndrome (CRS) that was identified
from the USs performed.
Study Design This study is a retrospective review of spinal USs performed between January 1, 2006,
and December 31, 2021, in newborns at a single institution. Indications for each US
and any associated abnormalities were noted. Infants with abnormal USs showing CRS
are described with their long-term medical outcomes.
Results A total of 592 USs were performed during the specified time period of which 72 (12%)
were abnormal. The presence of a sacral dimple was the most common indication for
performing a spinal US, although only 14 (4%) were identified as abnormal. Of these
14, 6 (43%) were further evaluated by spinal magnetic resonance imaging (MRI) at the
recommendations of a pediatric radiologist and of these, only 2 (14%) had abnormal
MRI findings. The two newborns with abnormal MRI findings had mothers with diabetes
mellitus in their pregnancies. Of note, one additional newborn had abnormalities on
spinal US that was never confirmed on MRI due to being lost to follow-up. Among the
other indications, anorectal anomalies (odds ratio [OR], 7.55; 95% confidence interval
[CI], 3.01–18.91), spinal mass (OR, 17.99; 95% CI, 7.86–41.2), and meningocele were
most associated with abnormal findings.
Conclusion Overall, spinal US has a low diagnostic yield. Sacral dimple was the most common
indication for performing a spinal US but had a low yield with few long-term sequelae.
Anorectal anomalies had a strong association with abnormal US findings.
Key Points
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Sacral dimple is a common indication for spinal ultrasound.
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Spinal ultrasound has low diagnostic yield when performed for sacral dimple.
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Caudal regression syndrome is associated with maternal diabetes and numerous long-term
comorbidities.
Keywords
sacral dimple - spinal ultrasound - caudal regression syndrome - maternal diabetes
