Approach to Pediatric Spine

Ultrasound

In the newborn, the spine is most commonly imaged when a cutaneous lesion overlies the lumbosacral spine & implies the presence of an underlying spinal abnormality. Common examples requiring deeper imaging investigation include a cutaneous infantile hemangioma, hairy patch, fatty mass, appendage, forked gluteal crease, or atypical dimple (& do not include the common low-lying, shallow midline dimple near the anus). Within the first 4 months of life, ultrasound excels at visualizing the morphologies & spatial relationships of structures within the spinal canal, including the spinal cord, CSF, & nerve roots. This allows for the detection of a low-lying conus medullaris or intraspinal mass that can be associated with tethering & will require release to prevent long-term neurologic damage. After about 4-6 months of age, too much of the pediatric vertebral cartilage has ossified to allow an adequate acoustic window into the spine. Therefore, other methods of interrogation will be required.