Screening spinal ultrasound in newborns with neural tube defects

Area of Science:

• Pediatric Surgery
• Diagnostic Imaging
• Neonatal Neurology

Background:

• Spina bifida, a complex neural tube defect, often presents with associated spinal anomalies.
• Accurate prenatal and postnatal diagnosis is crucial for effective surgical planning and management.
• Spinal ultrasound (US) is a non-invasive imaging modality used in neonates.

Purpose of the Study:

• To evaluate the utility of complete spinal ultrasound (US) in identifying associated spinal anomalies in newborns diagnosed with spina bifida prior to surgical repair.
• To assess the impact of US findings on the planned surgical intervention.
• To determine the accuracy of US in detecting neural elements within closed meningoceles.

Main Methods:

• A retrospective review of 26 newborns with spina bifida who underwent complete spinal US before initial surgical repair.
• Analysis of US findings for associated anomalies such as diastematomyelia, hydromyelia, and dural fat deposits.
• Correlation of US results with surgical findings, particularly for closed simple meningoceles.

Main Results:

• Associated anomalies were identified in 7 out of 26 infants (27%) on screening US.
• Specific anomalies included diastematomyelia (2 cases), hydromyelia (2 cases), and dural fat deposits (3 cases).
• Surgical therapy was altered in one infant due to the presence of diastematomyelia. US correctly identified four closed simple meningoceles as lacking neural elements, confirmed at surgery.

Conclusions:

• Complete spinal ultrasound is a valuable tool for detecting associated spinal anomalies in newborns with spina bifida before surgical repair.
• US findings can influence surgical strategy and improve the accuracy of preoperative assessment.
• Spinal US demonstrates high accuracy in ruling out neural elements in closed meningoceles, aiding in surgical decision-making.