Ultrasound of the spine in neonates and infants: a practical guide

Ultrasound of the spine in neonates and infants: a practical guide

REVIEWED BY Leanne Lamborn | ASA SIG: Paediatric

REFERENCE | Authors: Emilio J Inarejos Clemente, Maria Navallas Irujo, Oscar M Navarro, Barbara Salas Flores, Paulino Sousa Cacheiro, Enrique Ladera, Monica Rebollo Polo, Marta Tijerin Bueno, Ignasi Barber Martinez de la Torre

WHY THE REVIEW WAS PUBLISHED

Ultrasound is the imaging of choice when screening the spinal cord for closed dysraphism in neonates and infants. This examination is usually performed prior to the posterior elements of the vertebral column ossifying. Open dysraphism and after ossification occurs, magnetic resonance imaging (MRI) is the modality of choice. Ultrasound is important in assessment of the spinal cord and help in delineating the spinal anatomy, with the most common clinical indication being atypical sacral dimple. Ultrasound being non-ionising provides a quick, non-invasive and relatively inexpensive examination when compared to MRI.

This article discusses the fundamental role of ultrasound in neonatal and paediatric spinal imaging. It describes in detail the best techniques used, including ultrasound transducer selection, patient/transducer position and protocols for the evaluation of the neonatal spine. It outlines the most common normal variants in neonates and infants. It identifies and describes the US appearance of the most common congenital variations and pathologies in the spine. Prenatal MRI and postnatal MRI are also discussed.

WHY THE STUDY WAS PERFORMED

The aim of the paper was to look at how the ultrasound assessment of the spinal column is performed in neonates and infants younger than 3–4 months. There are several normal variants that the examiner needs to be aware of to avoid misdiagnosis of a spinal abnormality. This information, along with technique and protocol, makes the assessment of the neonatal spine easy with its systematic approach. It describes several other uses of ultrasound in assessing the spine where spinal dysraphism is not the question.

WHAT THE PAPER LOOKED AT

Technique

Neonatal spinal ultrasound technique is discussed, pointing out the real-time visualisation of spinal pathologies, expressing that a tailored ultrasound exam to answer the clinical question is crucial. The acoustic window and transducer choice depend greatly on the size of the child and if posterior elements are ossified. The protocol, checklist and landmarks used are well described.

Normal variants

There are several normal variants seen when assessing the neonatal/infant spine that the sonographer/radiologist should be aware of to ensure more accurate reporting. These are often seen in spinal examinations but are of no clinical significance.

Clinical indication for spinal ultrasound and management

There is a table of risks from clinical indications and the likelihood of a spinal abnormality.

Common pathology

It describes and discusses clearly how common pathology is visualised on ultrasound.

Other spinal ultrasound uses

It describes several uses of ultrasound not associated with spinal dysraphism.

“Is an excellent resource for any department that performs neonatal spine ultrasound from a general ultrasound practice to a tertiary level paediatric ultrasound site.”

RELEVANCE TO CLINICAL PRACTICE

The main purpose of this article is a practical guide for the examiner specifying the best way to approach, perform and assess a neonatal spine ultrasound examination. The article provides a systemic and comprehensive description in how to attain this. It is an excellent resource for any department that performs neonatal spine ultrasound from a general ultrasound practice to a tertiary level paediatric ultrasound site. The article helps to optimise patient care by helping ensure that normal anomalies are considered and that any abnormal findings are then investigated with further imaging to help with directing patient management.