From the Guidelines
The management of gluteal cleft abnormalities in newborns primarily involves careful observation and conservative measures, with surgical correction required only for abnormal tracts, such as those associated with surrounding cutaneous manifestations or located cranial to the gluteal cleft on the flat part of the sacrum 1. When evaluating gluteal cleft abnormalities, it is essential to differentiate between benign findings, such as coccygeal dimples, and those that may indicate underlying spinal dysraphism.
- Coccygeal dimples, which are typically located within a centimeter of the coccyx and below an imaginary line between the tops of the gluteal cleft, are considered normal and do not require further workup or treatment 1.
- In contrast, abnormal tracts, such as those associated with vascular anomalies, tufts of hair, skin tags, or subcutaneous dermoid masses, are always abnormal and require surgical correction to prevent complications like CNS infections or neurologic deterioration 1. Key considerations in the management approach include:
- Location and depth of the gluteal cleft abnormality
- Presence of associated cutaneous manifestations
- Neurological symptoms or signs of tethering
- The need for imaging studies, such as ultrasound or MRI, to rule out spinal dysraphism in cases with concerning features
- Maintenance of good hygiene and parental education on warning signs that require medical attention, such as drainage, increasing redness, swelling, or neurological changes 1.
From the Research
Management Approach for Gluteal Cleft Abnormalities in Newborns
The management of gluteal cleft abnormalities in newborns can vary depending on the specific condition and the presence of other symptoms.
- Asymptomatic newborns with subcutaneous lipomas, faun tail nevi, large skin tags, or deep/atypical lumbosacral dimples should prompt an imaging study, according to a study by pediatric neurosurgeons 2.
- Simple coccygeal dimples do not typically require imaging 2.
- The management of certain gluteal cleft deviations and cutaneous vascular marks has poor agreement among pediatric neurosurgeons, indicating a need for further research and guidance 2.
Imaging Studies for Gluteal Cleft Abnormalities
Imaging studies, such as MRI, can be used to detect occult spinal dysraphism in infants with gluteal cleft abnormalities.
- A study found that the prevalence of occult spinal dysraphism identified with modern high-resolution MRI screening is significantly higher than that reported with US screening, particularly in patients with dimples 3.
- Another study found that spinal ultrasound is a common initial action for infants with lumbosacral findings, but there is variation in the management approach among clinicians 4.
Clinical Significance and Treatment
The clinical significance of gluteal cleft abnormalities and the need for treatment depend on the specific condition and the presence of other symptoms.
- A study found that coccygectomy via a paramedian approach can be an effective treatment for refractory coccydynia, with a low infection rate and significant improvement in pain and disability scores 5.
- Another study highlighted the importance of differentiating between potentially dangerous dimples associated with dermal sinus and harmless coccygeal dimples in the cranial gluteal cleft, and the value of ultrasound and MRI in making this distinction 6.