What does isolated tuft of sacral hair signify?

From the Guidelines

Isolated tuft of sacral hair may be a normal variant, but it can also be associated with underlying spinal abnormalities, and therefore, it is crucial to evaluate for any accompanying cutaneous markers or neurological symptoms. When evaluating an isolated tuft of sacral hair, it is essential to consider the possibility of underlying spinal cord malformations, particularly split cord malformations, as noted in a study published in Pediatrics in 2015 1. The presence of a tuft of hair, especially when accompanied by other cutaneous markers such as dimples, skin discoloration, or subcutaneous masses, may indicate an increased risk of spinal abnormalities.

Key Considerations

• The location and characteristics of the hair tuft, as well as the presence of any accompanying cutaneous markers or neurological symptoms, are critical in determining the need for further evaluation.
• A study published in Pediatrics in 2019 1 recommends ultrasonography as the initial imaging modality when the diagnosis is uncertain, but MRI may be required to provide greater definition, especially if there is a high suspicion of spinal abnormalities.
• The American Academy of Pediatrics guidelines, as outlined in a 2015 study 1, suggest that isolated coccygeal dimples do not require further workup or treatment, but dimples located above the gluteal cleft or accompanied by cutaneous manifestations may indicate an underlying spinal abnormality.

Recommendations

• If an isolated tuft of sacral hair is noted, a thorough evaluation should be performed to check for any accompanying cutaneous markers or neurological symptoms.
• Imaging studies, such as ultrasound or MRI, may be ordered to check for underlying spinal abnormalities, especially if there are accompanying cutaneous markers or neurological symptoms.
• Consultation with a specialist, such as a pediatric neurologist or neurosurgeon, may be helpful in determining the need for imaging and which studies should be performed, as noted in a study published in Pediatrics in 2019 1.

From the Research

Isolated Tuft of Sacral Hair

• An isolated tuft of sacral hair may be a cutaneous stigma that indicates an underlying dysraphic malformation of the lower spinal canal 2
• Cutaneous stigmata, such as hairy patches, subcutaneous lipomas, capillary hemangiomas, dorsal dermal sinuses, and sacral cutaneous pits, can be associated with occult spinal dysraphism 2
• The presence of a tuft of sacral hair may warrant further clinical examination, including neurological signs and symptoms, urological disturbances, and orthopaedic deformities in the lower limbs 2
• Spinal MRI is the imaging modality of choice in children presenting with features consistent with occult spinal dysraphism, which may include an isolated tuft of sacral hair 2

Related Conditions

• Spina bifida occulta is a congenital anomaly characterized by a midline defect affecting the nervous tissue and its bony and soft tissue coverings 2, 3, 4, 5
• The condition can be associated with various clinical implications, including urinary voiding problems, constipation, and orthopaedic deformities 2, 4, 5, 6
• A higher position of the sacral hiatus can be a characteristic of spina bifida, which may have clinical implications for anesthetists, neurologists, radiologists, and orthopedic surgeons 5