Differential diagnosis of spinal dysraphism

Approach to the differential diagnosis of spinal dysraphism:

  • Suspected spinal dysraphism is most commonly encountered clinically as a sacral dimple in a newborn, which should be investigated with ultrasound to look for tethered cord
  • All other forms of spinal dyspraphism in a newborn whether open / overt / not skin covered lesions (spina bifida aperta = myelomeningocele and myelocele) or suspected closed / occult / skin covered lesions (spina bifida oculta = lipomyelomeningocele and lipomyelocele) should be investigated with MRI
  • Suspected spinal dysraphism in an older child (spina bifida oculta = tethered cord, fatty infiltration of the filum terminale) should be investigated by MRI