From the Guidelines
Management of a sacral dimple in neonates involves a thorough assessment to determine if the dimple is a simple, isolated finding or if it poses a risk for underlying spinal abnormalities, with the most recent and highest quality evidence guiding the approach. According to the most recent study 1, the management should prioritize the identification of risk factors associated with occult spinal dysraphism or tethered cord. For simple, isolated sacral dimples, which are typically less than 5 mm in diameter, have a visible base, are located within 2.5 cm of the anus, and are without other cutaneous markers, no further evaluation is typically needed as these are considered benign variants. However, for atypical or high-risk dimples, which are larger than 5 mm, have an invisible base, are located higher on the back, or are associated with other cutaneous markers like hair tufts, skin tags, or hemangiomas, ultrasound imaging is recommended within the first 3-4 months of life when vertebral ossification is incomplete, as suggested by 1 and 1.
Key considerations in the assessment include:
- Location of the dimple: Those located higher on the back are more concerning than those near the anus.
- Size and visibility of the base of the dimple: Larger dimples or those with an invisible base may indicate a higher risk.
- Presence of other cutaneous markers: Hair tufts, skin tags, or hemangiomas can be associated with spinal abnormalities.
- Physical examination findings: Assessment of lower extremity movement, tone, and reflexes, as well as anal tone and urinary patterns, is crucial.
If ultrasound findings are concerning or inconclusive, MRI may be necessary for further evaluation, especially to rule out tethered cord in the presence of a sacral dimple, as indicated by 1. Parents should be educated about warning signs that would warrant reassessment, including constipation, urinary retention, leg weakness, or developmental delays. The goal of early detection and management is to prevent progressive neurological deficits by allowing for timely neurosurgical intervention when necessary.
From the Research
Management of Sacral Dimple in Neonates
The management of sacral dimple in neonates involves a series of diagnostic steps to determine the presence of any underlying spinal cord abnormalities.
- Sacral dimples are a common cutaneous anomaly in infants, and most are benign 2, 3.
- However, the presence of a sacral dimple can be associated with occult spinal dysraphism, a condition that can lead to serious neurological complications if left untreated 4, 5, 6.
- The initial evaluation of a neonate with a sacral dimple typically involves a physical examination and a review of the infant's medical history.
- Imaging studies, such as ultrasonography or magnetic resonance imaging (MRI), may be ordered to further evaluate the presence of any spinal cord abnormalities 5, 2, 3, 6.
Diagnostic Imaging
- Ultrasonography is a useful screening tool for detecting spinal cord abnormalities in infants with a sacral dimple 5, 2, 3, 6.
- MRI is typically reserved for infants with abnormal ultrasonography findings or those with clinical signs of neurological involvement 5.
- The presence of a simple sacral dimple alone is a negligible marker for occult neural pathology, while the presence of isolated dermal sinus or more than one cutaneous marker could be considered indicative of higher risk of spinal dysraphism 5.
Treatment and Follow-up
- Infants with a sacral dimple and no evidence of spinal cord abnormalities can be safely discharged and followed up with routine pediatric care 2, 3.
- Those with suspected spinal cord abnormalities may require further evaluation and treatment by a pediatric neurosurgeon or other specialist 4, 5, 6.
- Follow-up imaging studies may be ordered to monitor the infant's condition and detect any potential complications early on 2.