Prenatal findings and postnatal outcomes in cases of closed spinal dysraphism: 10-year two-center cohort study

To characterize prenatal ultrasound findings in fetuses with prenatally diagnosed closed spinal dysraphism (CSD) and report their postnatal management and functional outcomes at 18 and 36 months.

This retrospective cohort study included all fetuses with a prenatal diagnosis of CSD assessed between January 2014 and December 2024 at two tertiary centers (Fetal Medicine Department of Trousseau Hospital, Paris, France, and Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium). Lesions were reassessed and classified according to the updated Orphanet classification system for dysraphisms. Cases of open dysraphism, intermediate forms, Currarino syndrome, caudal regression syndrome and postnatally diagnosed cases were excluded. Prenatal imaging findings, pregnancy outcomes, postnatal diagnostic concordance, neurosurgical management and functional outcomes were analyzed.

Seventy fetuses with a prenatal diagnosis of CSD were included. Saccular forms of CSD accounted for 85.7% (n = 60) of cases, including 33 (47.1%) cases of limited dorsal myeloschisis, 18 (25.7%) cases of posterior meningocele and nine (12.9%) cases of conus spinal cord lipoma. Most (85.7%) lesions were located at the lumbar or sacral level. Associated structural cerebral anomalies were identified prenatally in 17.1% (n = 12) of cases. There were 59 (84.3%) live births and 11 (15.7%) terminations of pregnancy, including eight cases with major cerebral anomalies. Among liveborn infants with available data on postnatal surgical interventions (n/N = 44/59), postnatal surgery was performed in 90.9% of cases. The prenatal diagnosis was adjusted postnatally in 4/39 (10.3%) cases with available postnatal outcome data. At 36 months, independent ambulation was achieved in 94.4% (17/18) of children with follow-up data available at this time point. In contrast, urinary dysfunction was present in 38.9% of cases at 36 months, while gastrointestinal disorders were less frequent (22.2%).

Using the Orphanet classification, prenatal ultrasound examination allows reliable anatomical characterization of CSD in 89.7% of cases. Motor outcomes are generally favorable, whereas urological morbidity is observed in nearly half of cases at 18 months. These are important elements to consider in prenatal counseling. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.