Sacral Dimples

Holly A. Zywicke; Curtis J. Rozzelle

doi:10.1542/pir.32-3-109

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Holly A. Zywicke, MD*
Curtis J. Rozzelle, MD^†

^*Division of Pediatric Neurosurgery, Department of Surgery, University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, AL.
^†Assistant Professor, Department of Surgery, Division of Pediatric Neurosurgery, University of Alabama at Birmingham and Children's Hospital of Alabama, Birmingham, AL.

Author Disclosure
Drs Zywicke and Rozzelle have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Objectives

After completing this article, readers should be able to:

Explain the difference between open and closed neural tube defects.
Describe the characteristics of spinal skin dimples that warrant further evaluation.
Describe the characteristics of spinal skin dimples that do not warrant further evaluation.
Discuss the evaluation of spinal skin dimples and name the findings that suggest occult spinal dysraphism.
Discuss the neurosurgical treatment of occult spinal dysraphism.
Explain the natural history and clinical manifestations of occult spinal dysraphism.

Definitions

Neural tube defects are among the most common forms of birth defect, affecting 1 in every 1,000 pregnancies. (1)(2) These defects, which result from abnormal fusion of the neural tube during embryonic development, are placed into two broad categories: open and closed. Open neural tube defects are lesions in which brain, spinal cord, or spinal nerves are exposed through obvious defects of the meninges and skull or vertebral column. Examples are anencephaly, myelomeningocele, and meningocele. Closed neural tube defects are skin-covered lesions under which the nervous system structures have not formed normally. These include split cord malformation, dermal sinus tract, tethered spinal cord, and intraspinal lipoma (Table).

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Table.

Definitions

Spina bifida is an imprecise term often used to describe a variety of congenital spinal anomalies that range in consequence from insignificant to severe. Spina bifida occulta (SBO) is a radiographic finding that describes incomplete osseous fusion of the posterior elements. It may occur in conjunction with a cutaneous abnormality but is clinically benign and is considered a normal variant. (3) Occult spinal dysraphisms (OSDs) are much less common than SBO and encompass a variety of skin-covered neural tube defects. Because …