Spine injuries in baseball players | cervical spine injuries | Colorado Spine Surgeon
Neonatal spine ultrasound...normal and abnormal findings
-
Upload
ahmed-bahnassy -
Category
Health & Medicine
-
view
10.447 -
download
2
description
Transcript of Neonatal spine ultrasound...normal and abnormal findings
![Page 1: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/1.jpg)
Dr/Ahmed Bahnassy
Consultant Radiologist
Riyadh Military Hospital
![Page 2: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/2.jpg)
Why US spines ?
Spinal ultrasound (SUS) is becoming increasingly accepted as a first line screening test in neonates suspected of spinal dysraphism .
![Page 3: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/3.jpg)
Challenging MRI
The advantages of SUS are not only a diagnostic sensitivity equal to MRI but that, unlike MRI, SUS can be performed portably, without the need for sedation or general anaesthesia.
In addition, MRI is highly dependent on factors affecting resolution, including patient movement, physiological motion from cerebral spinal fluid (CSF) pulsation and vascular flow, factors that do not affect SUS . New generation high frequency ultrasound machines
with extended field of view capability now permit imaging of high diagnostic quality in young babies.
![Page 4: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/4.jpg)
When to perform ?
SUS is possible in the neonate owing to a lackof ossification of the predominantly cartilaginousposterior arch of the spine . The quality ofultrasound assessment decreases after the first3–4 months of life as posterior spinous elementsossify, and in most children SUS is not possiblebeyond 6 months of age. However, the persistingacoustic window in children with posterior spinaldefects of SD enables ultrasound to be performedat any age
![Page 5: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/5.jpg)
When to request US spines ?Current RCR guidelines are thatall neonates with a hairy patch or sacral dimple should undergo SUS . However, while more than 90% of patients with occult SD have a cutaneous abnormality over the lower spine , a cutaneous marker may have a low yield in predicting the presence of a clinically significant abnormality. In a recent review of 200 SUS examinations performed over an 11-year period, SD was found in less than 1% of cases when a cutaneous marker was the only clinically detectedabnormality .
![Page 6: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/6.jpg)
Gastrulation stage
![Page 7: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/7.jpg)
Neurulation stage
![Page 8: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/8.jpg)
Retrogressive differentiation and relative cord ascent
Formation of the ventriculus terminalis, the
caudal portion of the conus medullaris, and the filum terminale through the processes of canalization and retrogressive
differentiation.
![Page 9: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/9.jpg)
Sonographic examination of the neonatal spine is performed with the infant in a warm room lying in a prone, lateral decubitus, or semi-erect position.
Feeding the infant before examination helps him
or her to relax. Placing a towel under the infant’s pelvis will flex
the spine enough to separate the midline posterior arches .
.
![Page 10: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/10.jpg)
A high frequency (7- to 15-MHz) linear-array transducer should be used .. higher frequency transducers are beneficial for optimization of superficial structures such as skin lesions and sinus tracts.
Extended field-of-view (EFOV) imaging is
an additional feature that can demonstrate the whole neonatal spine from T12 to the coccyx
![Page 11: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/11.jpg)
• Mark T 12 in transverse plane (presence of ribs witnessing)
• Then count downwards to end of cord.
![Page 12: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/12.jpg)
Alternatively by
Locating the last lumbar vertebra, L5, byevaluating the lumbosacral junction. Thencount cephalad to the conus medullaris.
Locating the last ossified vertebral body,the first coccygeal segment. Then count thefive sacral segments cephalad into thelumbar vertebra.
![Page 13: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/13.jpg)
The spinal cord lies in the spinal canal within anechoic CSF of the subarachnoid space. Surrounding
the canal is the dura mater, which is shown by anechogenic line dorsal and ventral to the canal. The
cord is lined with the arachnoid sheet, which exhibits an echogenic line parallel to the cord’s surface.
Caudally, the lumbar enlargement tapers, forming the conus medullaris, which extends and becomes the filum terminale.
![Page 14: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/14.jpg)
Filum teminale
The filum terminale images as an echogenic cordlike structure that is surrounded by echogenic nerve roots of the cauda
equina. For that reason, separation of the two is difficult.
However, the filum terminale is commonly more echogenic than the surrounding cauda equina.
The filum terminale normally measure less than or equal to 2 mm.
![Page 15: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/15.jpg)
Cord
On a sagittal image, the spinal cord appears asa hypoechoic cylindrical structure with two echogeniccomplexes centrally. These represent thecentral echo complex. The normal cord lies onethird to one half of the way between the dorsal andventral walls of the spinal canal On a transverse image, the cervical spinal cordappears as an oval shape, whereas the thoracic andlumbar portions are more circular.
![Page 16: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/16.jpg)
Conus level
The level of the conus usually ends between T12 and L1 or L2 .If it ends at the L2-L3 disk space or
lower, it is abnormal, and one should explore for any tethering masses. However, it must be noted that a normal cord may lie around L3, mainly in preterm infants.
The normal position of the cord should be centralin the spinal canal. The spinal cord is held in placeby echogenic dentate ligaments passing laterallyfrom each side of the cord.
The normal spinal cord produces a rhythmic movement
![Page 17: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/17.jpg)
• Standard views
![Page 18: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/18.jpg)
![Page 19: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/19.jpg)
Cystic ventriculus terminalis (normal variant)
![Page 20: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/20.jpg)
Cystic distension of distal spinal canal (normal variant )
Size smaller than
5 mm and stability over time
distinguish this normal variant
from small syrinx.
![Page 21: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/21.jpg)
Filar cyst (normal variant)
criteria for filar cyst:
location just below
conus medullaris, fusiform shape, well defined, thin walled, and hypoechoic.
![Page 22: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/22.jpg)
Pseudo-masses
• Clumped nerve roots..
• Use 2 planes..to see the whole length of nerve root.
![Page 23: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/23.jpg)
Dysmorphic coccyx
• Cartilagenous angulated lesion.
• Not dermal sinus track.
![Page 24: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/24.jpg)
Three processes can lead to congenital anomalies:
First, premature separation of the skin ectoderm from the neural tube can lead to entrapment of mesodermal elements, such as fat.
Second, failed neurulation leads to dysraphisms,
such as myelomeningocele(overt or closed )
![Page 25: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/25.jpg)
Last ,anomalies of the filum terminale, such as fibrolipomas and caudal regression syndrome caused by disembryogenesis of the caudal cell mass
![Page 26: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/26.jpg)
Classification
Congenital spinal dysraphisms can be classified on the basis of the presence or absence
of a soft-tissue mass and skin covering .
Those without a mass include tethered cord,
diastematomyelia, anterior sacral meningocele,
and spinal lipoma.
Those with a skin covered soft-tissue mass include lipomyelomeningocele and myelocystocele.
And those with a back mass but without skin covering include myelomeningocele and myelocele
![Page 27: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/27.jpg)
![Page 28: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/28.jpg)
![Page 29: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/29.jpg)
Lipoma
![Page 30: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/30.jpg)
Dorsal dermal sinus track
![Page 31: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/31.jpg)
Tethered cord
Sonographically, tethered cord is diagnosedin neonates by the presence of a low-lyingconus (below the L2–L3 disk space) andlack of normal nerve root motion during realtimesonography
Search for cause
![Page 32: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/32.jpg)
Intradural lipoma
• Hyperechoic dural mass..
• Tethered cord.
![Page 33: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/33.jpg)
Thick filum terminale
![Page 34: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/34.jpg)
Fatty filum
![Page 35: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/35.jpg)
Lipoma of filum terminale
Tethered cord
L3
![Page 36: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/36.jpg)
Diastematomyelia
• Echogenic spur between two hemicords in transverse image.
![Page 37: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/37.jpg)
Caudal regression syndrome
• Blunted conus medullaris.
• Fatty filum• Absence of sacral
vertebrae and coccyx .
![Page 38: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/38.jpg)
Myelomeningocele
• Cystic mass (CSF)
• +tethered cord
• +neural elements.
• +soft tissue mass
![Page 39: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/39.jpg)
Unilocular meningocele
![Page 40: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/40.jpg)
Lipomyelomenimgeocyle
![Page 41: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/41.jpg)
![Page 42: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/42.jpg)
Neuroblastoma
![Page 43: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/43.jpg)
Sacrococcygeal teratoma
![Page 44: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/44.jpg)
Other renal anomalies
![Page 45: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/45.jpg)
![Page 46: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/46.jpg)
![Page 47: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/47.jpg)
![Page 48: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/48.jpg)
![Page 49: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/49.jpg)
![Page 50: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/50.jpg)
Conclusion• Spinal ultrasound (SUS) is becoming
accepted as a first line screening test in neonates with high sensitivity and specificity.
• Recognizing normal anatomy ,variants and congenital anomalies early in life help in futur planning of management .
![Page 51: Neonatal spine ultrasound...normal and abnormal findings](https://reader036.fdocuments.us/reader036/viewer/2022081403/554b2ecfb4c905a2058b4df3/html5/thumbnails/51.jpg)