Diagnostic Utility of Spinal Ultrasounds in Neonates

Abstract

Objective: Ultrasound is a common imaging modality used to evaluate spinal anomalies in newborns. However, many indications for the use of spinal ultrasound are associated with low diagnostic yield. The purpose of this study is to evaluate the indications and the diagnostic utility of spinal ultrasounds performed in newborns. We also review patient presentations for caudal regression syndrome that was identified from the ultrasounds performed. Study Design: This study is a retrospective review of spinal ultrasounds performed between January 1, 2006 to December 31, 2021 in newborns at a single institution. Indications for each ultrasound and any associated abnormalities were noted. Infants with abnormal ultrasounds showing caudal regression syndrome are described with their long – term medical outcomes. Results: A total of 592 ultrasounds were performed during the specified time period of which 72 (12%) were abnormal. Presence of a sacral dimple was the most common indication for performing a spinal ultrasound, although only 14 (4%) were identified as abnormal. Of these 14, six (43%) were further evaluated by spinal MRI at the recommendations of a pediatric radiologist and of these only two (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 followup. Among the other indications, anorectal anomalies (odds ratio [OR] 7.55; 95% confidence interval [CI] 3.01 to 18.91), spinal mass (OR, 17.99; 95% CI 7.86 to 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.

Ultrasound‐Guided Prospective Screening for Spinal Dysraphism in Offspring of Mothers With Pregestational Diabetes

“…Although the diagnostic yield of these studies is low, sacral dimple or other cutaneous findings in the setting of PGDM were associated with spinal anomalies and should thus be considered as part of the screening criteria. 13…”

“…Finally, infants of mothers with PGDM with cutaneous anomalies such as sacral dimple noted on physical examination routinely receive spinal ultrasounds to identify cord anomalies. Although the diagnostic yield of these studies is low, sacral dimple or other cutaneous findings in the setting of PGDM were associated with spinal anomalies and should thus be considered as part of the screening criteria 13 …”