What is the management of a benign sacral dimple?

From the Guidelines

Benign sacral dimples do not require further workup or treatment, and management primarily involves observation and monitoring. The key to determining the appropriate management of a sacral dimple is distinguishing between a benign coccygeal dimple and a potentially pathologic lumbosacral dorsal spinal tract (DST) 1. A benign sacral dimple is typically located at or below an imaginary line drawn between the tops of the gluteal cleft, has no associated skin abnormalities, and is not connected to the spinal cord 1. Some important characteristics of benign sacral dimples include:

• Location at or below the gluteal cleft
• No associated skin abnormalities
• No connection to the spinal cord
• Lack of concerning features such as hair, skin tags, discoloration, or associated cutaneous abnormalities For these benign dimples, no imaging or surgical intervention is necessary 1. Parents should be educated to keep the area clean and dry during diaper changes to prevent infection. During routine well-child visits, healthcare providers should continue to monitor neurological development, including lower extremity strength, reflexes, and bladder/bowel function 1. If any concerning changes develop, such as neurological symptoms, urinary or fecal incontinence, or changes in the appearance of the dimple, further evaluation with ultrasound or MRI may be warranted to rule out spinal dysraphism or tethered cord 1. The conservative approach is justified because truly benign sacral dimples have an extremely low risk of being associated with underlying spinal abnormalities, making invasive investigations unnecessary in the absence of concerning features.

From the Research

Management of Benign Sacral Dimple

The management of a benign sacral dimple is primarily focused on determining whether the dimple is associated with any underlying spinal abnormalities.

• A sacral dimple measuring less than 5mm, within 25mm of the anus on the median line, with no other cutaneous anomaly, does not require any complementary examination 2.
• Parents of infants with such dimples can be reassured, as the risk of significant spinal malformations is low 3.
• However, any cutaneous depression in the sacrolumbar region not respecting these criteria must be considered as an occult dysraphism until proved otherwise 2.
• In such cases, a medullary ultrasound examination and a consultation with a specialist (pediatric neurosurgeon) are necessary 2.
• Spine ultrasonography (USG) is an effective and safe screening tool for patients with a sacral dimple, and can be recommended for its convenience and safety 4.
• The majority of infants with a sacral dimple have benign imaging findings, and only a small percentage require surgical intervention 4, 3.
• It is essential to differentiate a benign sacral dimple from other conditions, such as a dermal sinus tract, which can have serious complications if left untreated 5, 6.
• Early diagnosis and treatment of underlying spinal abnormalities can significantly improve outcomes and prevent long-term sequelae 5, 6.