Neonatal/Infant Spine

Neonatal-Infant Spinal Sonography

Spine ultrasound provides a high resolution imaging technique to rule out common and uncommon vertebral column pathologies like tethered cord syndrome and other spinal dysraphisms.

 

Indications

  1. Midline or paramedian masses
  2. Midline skin discolorations
  3. Skin tags
  4. Hair tufts
  5. Hemangiomas
  6. Small midline dimples
  7. Paramedian deep dimples

Preparation

Make sure infant is well fed to reduce fussiness and potential crying, use warm gel and lay patient prone with small towel roll under umbilicus to arch back.

 

Anatomy

spinal-column-vertebral-column

The vertebral column is divided into 4 segments; A cervical portion which is the most cephalad and located in the neck contains 7 bones labeled C-1 through C-7. The second segment is the thoracic vertebrae, it is the largest segment just below the neck located in the chest and contains 12 bones. Inferior to this is the lumbar vertebrae which contains 5 bones that are quite broad in comparison. Lastly is the sacrum  a large, triangular bone at the base of the spine. It forms by the fusing of sacral vertebrae S1–S5.

3

 

 

Spinal cord

The spinal cord is a tubular bundle of nuerons that send and receive signals to your body, it leaves the brain via the foramen magnum and descends through the vertebral foramen continuing downward  until it becomes bulbous in the lumbar region finally tapering down to the conus medullaris near the second lumbar vertebra. It terminates as the filum terminale (continuation of pia mater) and cauda equina (latin for horse’s tail, bundle of nerve roots).

Finding the Conus

You can either count from the sacrococcygeal area  there will be 5 sacral and 5 lumbar vertebrae, the conus medullaris should end at of before L2

Another method is to use the last rib, while scanning int the lumbo-thoracic region angle laterally and you will encounter echogenic spherical structures that are the ribs. Find the last rib, this should be your the 12th rib associated with T12. L1 and L2 should follow caudally. A potential pitfall with this method is that some people have 11 or 13 pairs of ribs, which is why both methods should be used to improve accuracy.

Mild Dilatation of the Central Canal

A slight dilatation of the spinal cords central canalis sometimes observed in newborns. It is an incidental finding considered to be a normal variant and of no clinical significance. It is not to be mistaken for a syrinx.

ventriculuc

Ventriculus Terminalis

The ventriculus terminalis is a small, ependyma-lined, oval, cystic structure positioned at the transition from the tip of the conus medullaris to the origin of the filum terminale. The ventriculus terminalis develops during embryogenesis as a result of canalization and retrogressive differentiation of the caudal end of the developing spinal cord and regresses in size during the first weeks after birth . This variant causes no clinical symptoms.

 

 

indianjradiolimaging_2016_26_4_493_195788_f7
Indian Journal of Radiology and Imaging

 

Filar Cyst

This is a cystic structure that is routinely seen within the substance of the Filum. Also of no clinical significance.

fig-112

Tethered Cord

Tethered cord is a syndrome with several causes in which the spinal cord is pulled tight due to a mass or dysraphism like spina bifida.

The normal spinal cord moves freely within the spinal fluid filled canal. When there is tethering, the cord can be taut and attached to the vertebral column or subcutaneous tissues by a thickened filum terminale, dermal sinus tract, diastematomyelia (split cord), or a lipoma.

When this is present the conus medullaris will be located below L2, it can be located at L4 and even lower in more severe cases.

 

Tethered Cord with conus at L5 and dermal sinus tract

lbox_10284
ultrasoundcases.info

Tethered cord with conus at S2

tethered-cord-arm-4d-f-552302777-us-723397

Hydromyelia

10179

 

 

 

Sources:

Lisa H. Lowe  et. al. American Journal of Roentgenology. 2007;188: 733-738. 10.2214/AJR.05.2159

Karin, Unsinn M. et. al. “US of the Spinal Cord in Newborns: Spectrum of Normal Findings, Variants, Congenital Anomalies, and Acquired Diseases.” US of the Spinal Cord in Newborns. Radiographics, n.d. Web. 09 Feb. 2017.

http://ultrasoundcases.info/

https://www.researchgate.net/publication/221981217_Regional_anesthesia_in_children_The_future

http://www.aium.org/resources/guidelines/neonatalspine.pdf

http://pubs.rsna.org/doi/full/10.1148/radiographics.20.4.g00jl06923

 

http://www.ijri.org/article.asp?issn=0971-3026;year=2016;volume=26;issue=4;spage=493;epage=501;aulast=Nair

 

 

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s