neonatal spine

Question 1

When can we use sonography for evaluating the fetal spine?

Answer 1

infants under 6mo
surgical procedures
known spinal defects where an acoustic window is available

Question 2

What is spinal dysraphism?

Answer 2

array of spinal abnormalities caused by inadequate or improper fusion of the NT in early fetal life
2 types: open + closed

Question 3

Why would we need to perform an ultrasound on the spine?

Answer 3

spinal dysraphism: meningoceles, myelomeningoceles, lipomyelomeningoceles, lipomas
lumbosacral skin anomalies: pigmented spots, hairy nevus, dimples, hemangiomas, dermal sinuses

Question 4

What is a syrinx?

Answer 4

a rare, fluid-filled cavity within the spinal cord

Question 5

What patient position is used?

Answer 5

prone w/ towel or pillow under (rounds out back)

decub is also used “fetal position”

Question 6

Slide 9-16

Answer 6

has stuff highlighted but it’s like labelling stuff

Question 7

Spinal cord appears hypoechoic sonographically. T/F

Answer 7

true

Question 8

The cord tapers to the

Answer 8

conus medullaris (L1 + L2)

Question 9

What’s the measurement for filum terminale?

Answer 9

<2mm

Question 10

What do nerve roots appear as sonographically?

Answer 10

small echogenic dots or clumps together

sometimes obscuring filum terminale

Question 11

The cord is smaller in the cervical region, narrows in thoracic region and enlarges at the conus. True or false

Answer 11

False- it is larger in the cervical region and then narrows in the thoracic segment

Question 12

When should the spinal cord terminate?

Answer 12

L1 + L2

Question 13

What embryonic structure forms the spine?

Answer 13

ectoderm

Question 14

Each end of the neural tube closes. If the anterior neuropore doesn’t close, what happens? The posterior neuropore?

Answer 14

anterior- anencephaly

posterior- spina bifida, p

Question 15

Ventriculus terminalis is a normal variant. What is it?

Answer 15

a slight widening of the distal central canal
the echogenic walls of the central canal are slightly separated by anechoic fluid near the conus
doesn’t extend cranially into the the thoracic region

Question 16

What is a filar cyst?

Answer 16

normal variant

ovoid midline anechoic structure just inferior to the tip of the conus

Question 17

Where is spinal dysraphism most common?

Answer 17

lower spine

Question 18

Open spinal dysraphism:

Answer 18

neural tissue exposed without skin covering
myeloceles, myelomeningoceles
inc. AFP + maternal serum + amniotic fluid

Question 19

Closed spinal dysraphism:

Answer 19

skin covered spinal abnormality

can be with or without mass

Question 20

CSD with mass can be what? (3)

Answer 20

lipomyelocele
lipomyelomeningocele
myelocystocele

Question 21

CSD without a mass can be what? (4)

Answer 21

tethered cord
spinal lipoma
diastomyelia
dorsal dermal sinus

present as cutaneous markers (hair tufts, dimples or pits, hemangiomas, etc.)

Question 22

What’s the difference between a myelocele and a myelomeningocele?

Answer 22

myelocele is a herniation of the meninges through the dura mater and in an MMC it also includes the neural tissue

Question 23

What is more common, a myelocele or MMC?

Answer 23

MMC

Question 24

MMC is assoicated with?

Answer 24

Arnold Chiari II malformation

Question 25

What sonographic signs are seen with Arnold Chiari II malformation?

Answer 25

fruit sign | lemon + banana

Question 26

Banana shape refers to what structure?

Answer 26

cerebellum

Question 27

Tethered cords are almost always associated with?

Answer 27

dysraphic anomalies

Question 28

What symptoms does a child with a tetherd cord present ?

Answer 28

neurological symptoms- limb, bowel or urinary dysfunction | skin markers

Question 29

Sono appearance of tethered cord:

Answer 29

spinal cord in low lying postition (at or below L3) conus is elongated and pulled dorsally nerve roots have decreased movements thick filum terminale

Question 30

What is diastomyelia?

Answer 30

separation of the spinal cord into two hemicords | split by a bony or fibrous septum

Question 31

Where does diastomyelia most often occur?

Answer 31

thoracolumbar region usually has a cutaneous marker usually reunite distally

Question 32

What is a dorsal dermal sinus?

Answer 32

a thin, epithelial lined tract that passes from the skin toward the spinal canal mostly in lumbosacral region at risk for meningitis

Question 33

What is the most common reason for an infant to be referred to US (for the spine)?

Answer 33

sacral dimple/pit

Question 34

Where is a sacral dimple located?

Answer 34

<2.5 from the anus

Question 35

What should a sacral dimple not be confused with?

Answer 35

DDS because it has no connection to the spine

Question 36

Intradural lipoma:

Answer 36

lies within the spinal cord and is completely confined by the dura

Question 37

Lipomas of the filum terminale:

Answer 37

presents as a thickened FT >2mm, or a small echogenic fatty mass in the FT

Question 38

Lipomyelocele protrudes out from spinal cord. True/false

Answer 38

False

Question 39

Terminal myelocystocele:

Answer 39

skin covered fluid filled lumbar mass protruding through a dysraphic defect

Question 40

What is a terminal myelocystocele associated with?

Answer 40

omphalocele, bladder exstrophy and imperforated anus | decreased function of lower extremity (bowel + bladder)

Question 41

What can be seen with terminal myelocystocele? What is it?

Answer 41

hydromelia-- dilated central canal