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.
- Midline or paramedian masses
- Midline skin discolorations
- Skin tags
- Hair tufts
- Small midline dimples
- Paramedian deep dimples
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.
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.
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.
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.
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.
This is a cystic structure that is routinely seen within the substance of the Filum. Also of no clinical significance.
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
Tethered cord with conus at S2
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.