Ultrasound to Evaluate Neonatal Spinal Dysraphism: A First-Line Alternative to CT and MRI

The embryologic development of the spinal cord is a remarkably complex process. Spinal abnormalities can occur in isolation or be part of a clinical syndrome commonly summarized as spinal dysraphism. Proper evaluation of spinal malformations with imaging is required for early diagnosis prior to counseling and selection of postnatal treatment options. The preferred imaging modality of the spine in newborns up to 3 months of age are ultrasound (US) and magnetic resonance imaging (MRI). The diagnostic workup should preferably start with the safe, minimal invasive (no need for sedation), cost-effective, and bedside US as a screening procedure. On the other hand, need for sedation, thermal instability of infants, and high cost make the use of spinal MRI impracticable for screening purposes. US is also a well-established imaging modality to investigate the spinal cord and canal during pregnancy. It is critical to follow a strict protocol in an attempt to precisely identify all imaging findings, one should be familiar with the normal ultrasonographic appearance of bony and soft tissue structures in the various planes and one should be able to correlate the abnormal findings with spinal cord embryology as it aids in identifying the etiology. US should be considered as a first-line imaging for neonates suspected of spinal anomalies. In this article, we discuss up-to-date US technique of the spine, the most frequently encountered neonatal spinal malformations seen with US and correlate these findings with the relevant embryologic processes.