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Sacral dimple

Spinal dysraphism is a congenital disorder caused by abnormal closure of the neural tube ranging from asymptomatic spina bifida occulta to severe meningomyelocele or open tube defect. Some can be skin-covered and occult (tethered cord w/ spinal lipoma). Folic acid deficiency. Tethering of the cord causing mechanical traction and may impair the circulation causing progressive cord ischemia and neural dysfunction.

Cutaneous signs: Sacral dimple (may be completely normal), Hemangiomas, Hairy patches, Skin tags/tails, subcutaneous Lipomas, eccentric high lying dimples, hypertrophic/atrophic skin, gluteal cleft asymetries


Radiography

Non-fused posterior vertebral elements, pedicular widening, bony spurs, vertebral malformation (butterfly vertebrae, block or hemivertebrae)


Ultrasound

In first 3 months (because of caudo-cranial posterior elements fusion). Normal: conus medullaris terminates above L3, reaching the adult level of L1-L2 by 3 months of age. Cord lies within the ventral aspect of the thecal sac in the prone scanning position, anechoic CSF should be seen dorsal to the cord. Central echo complex, ventriculus terminalis, thecal sac at S2, bump L5-S1, last rib T12.

Tethered cord

Conus terminates below L3, often in echogenic fatty mass or lipoma.
MRI: confirmatory for low lying spinal cord, intrathecal mass/lipomas, thickened filum terminale, dermal sinus tracts