Ultrasonographic determination of neonatal spinal canal depth (original) (raw)

MR determination of neonatal spinal canal depth

European Journal of Radiology, 2012

Objectives: Lumbar punctures (LPs) are frequently performed in neonates and often result in traumatic haemorrhagic taps. Knowledge of the distance from the skin to the middle of the spinal canal (mid-spinal canal depth -MSCD) may reduce the incidence of traumatic taps, but there is little data in extremely premature or low birth weight neonates. Here, we determined the spinal canal depth at post-mortem in perinatal deaths using magnetic resonance imaging (MRI). Patients and methods: Spinal canal depth was measured in 78 post-mortem foetuses and perinatal cases (mean gestation 26 weeks; mean weight 1.04 kg) at the L3/L4 inter-vertebral space at post-mortem MRI. Both anterior (ASCD) and posterior (PSCD) spinal canal depth were measured; MSCD was calculated and modelled against weight and gestational age. Results: ASCD and PSCD (mm) correlated significantly with weight and gestational age (all r > 0.8). A simple linear model MSCD (mm) = 3 × Weight (kg) + 5 was the best fit, identifying an SCD value within the correct range for 87.2% (68/78) (95% CI (78.0, 92.9%)) cases. Gestational age did not add significantly to the predictive value of the model. Conclusion: There is a significant correlation between MSCD and body weight at post-mortem MRI in foetuses and perinatal deaths. If this association holds in preterm neonates, use of the formula MSCD (mm) = 3 × Weight (kg) + 5 could result in fewer traumatic LPs in this population.

Neonatal and infantile spinal sonography: A useful investigation often underutilized

The Indian journal of radiology & imaging

Sonography is an ideal, effective, noninvasive tool for evaluation of the spinal cord in neonatal and early infantile age groups owing to lack of ossification of the posterior elements of spine. Understanding normal anatomical appearances is a prerequisite for the interpretation of various pathologies of the spinal canal and its contents. This review elucidates normal appearances of the spinal cord in this age group, in both axial and sagittal planes. Usefulness of Doppler sonography is briefly discussed, and special emphasis is placed on normal anatomical variants that may mimic spinal abnormalities. Sonographic appearances of common intraspinal pathologies, both congenital and acquired, are exhaustively described. Key points regarding sonographic diagnosis of important spinal anomalies are emphasized and explained in detail. To conclude, spinal ultrasound is a reliable and widely available screening tool, albeit the usefulness of which is often underestimated.

Spinal ultrasound – Identification of the normal structures

Romanian Medical Journal

The incomplete ossification of the spinal processes allows the ultrasonographic evaluation of the spinal cord and the adjacent structures in neonates and small infants. The paper describes the ultrasonographic examination of the spinal structures and the normal appearance of the spinal cord, the structures within the spinal canal, and the bony and muscular adjacent structures. Sagittal and axial sections at cervical, thoracic, lumbar, and sacral levels are described. There are also mentioned findings in the M mode and Doppler examinations.

Atypical and equivocal sonographic features of the spinal cord in neonates

Pediatric radiology, 1995

Thanks to the wider use of sonography to examine the spinal content in the neonate, normal anatomy and anomalies may be detected easily. Yet, unusual sonographic patterns are also observed. These must be differentiated from true pathologies. During a prospective study of 103 neurologically asymptomatic neonates, atypical sonographic patterns were found in 16 patients, corresponding to normal variants in 13. Nine of these 13 patients presented with a widening of the distal part of the central echo complex (one had a dilated ventriculus terminalis). Nerve roots of the cauda equina were disposed asymmetrically in three patients; the spinal cord movements were still present. In two of these babies, this distribution was associated with thin arachnoid pseudocysts. One patient presented with transitorily hyperechoic and narrow subdural spaces, probably related to neonatal dehydration. None of the 13 patients showing normal variants required any treatment. The other 3 patients (of 16) presented with equivocal entities of unknown evolution: sonographic tethered cord, fibrolipoma of the filum terminale and epidural varices. Sonography is highly accurate in evaluating the spinal cord content and aids differentiation of normal and normal variants from equivocal or pathological entities.

Caprine neonatal spinal ultrasonography

International journal of developmental neuroscience : the official journal of the International Society for Developmental Neuroscience, 2017

Spinal ultrasonography is a safe, rapid, and non-invasive diagnostic tool that allows visualization of the spinal cord and its surrounding meninges. The non-ossified spinous processes were used as an acoustic window for imaging the spinal cord in human and canine neonates. No available literatures have been published describing the ultrasonographic appearance of caprine neonatal spinal cord. The present study was performed on 20 one day-old goat kids. Sagittal and transverse ultrasound scans were obtained using 8MHz linear transducer. The spinal cord appeared as a tubular anechoic to hypoechoic structure within the spinal canal. The cord was surrounded by hyperechoic dura and pia matter as well as the anechoic subarachnoid space in-between. The mean sagittal diameter of the cord at the cervical region was (4.6±0.3mm), the thoracic region (3.9±0.2mm), and the lumbar region (4.3±1.1mm). The sagittal diameter of the cord at the cervical and lumbar regions was significantly wider than t...

Spine Ultrasound Imaging in the Newborn

Seminars in Ultrasound, CT and MRI, 2014

Ultrasound of the spine in the neonate is widely used as the initial modality to evaluate spinal canal anatomy, anatomical variants, and congenital malformations. The spinal canal and its contents are best visualized in the newborn and young infant owing to incomplete ossification of the posterior vertebral elements.

Magnetic resonance imaging in the evaluation of the fetal spinal canal contents

Brain and Development, 2011

Ultrasonography (US) remains the first method in the evaluation of fetal central nervous system (CNS) abnormalities but in case of the spinal canal and cord it is often insufficient since the bony structures may obscure these structures. Prenatal magnetic resonance imaging (MRI) is therefore the final noninvasive tool for the assessment of these malformations allowing for correction of sonographic findings, revealing the full extent of complex lesions and choosing the candidates for in utero treatment. The authors present the most frequent anomalies of spinal canal and spinal cord in the consecutive phases of pregnancy, illustrated with their own MR images, with reference to the literature and own experience. In 58 out of 252 fetuses examined due to suspicion of CNS anomalies (23.0%) the spinal canal and spinal cord abnormalities were found on MRI. The cases of diastematomyelia, myelomeningocele, tethered cord, caudal regression syndrome, anterior meningocele, cystic sacrococcygeal teratoma and syringohydromyelia are demonstrated.

Weight-based determination of spinal canal depth for paediatric lumbar punctures

Archives of Disease in Childhood, 2013

Objectives The aim of this study was to evaluate whether spinal canal depth (SCD), measured using ultrasound, could be estimated from simple body measurements in a sample of children. Methods We measured SCD in a group of 225 children aged 0-18 years in the curved left lateral position using ultrasound. Statistical analysis was performed using Pearson's correlation coefficient at the 5% level of significance. We also performed linear regression analyses (analysis of variance) for mid-spinal canal depth (MSCD), including five potential predictors of age, gender, height, weight and body surface area, in each model. Results The mean MSCD was 33.0 mm (18.1-56.4) across the whole cohort. The best linear correlation of MSCD (mm) was found with weight (W; kg), approximating the formula MSCD=0.4W+20 (R 2 =0.72). Body weight accounted for 85% of the variance in the data (adjusted R 2 =0.72). Our formula gives values outside of the actual measured SCD range in 23/225 (10.2%) of cases and estimates MSCD at 24 mm at 10 kg, 32 mm at 30 kg and 40 mm at 50 kg. Conclusions We demonstrate a good correlation between weight and MSCD in a large group of children. Use of the simple formula MSCD (mm)=0.4 W+20 could improve the success rates of lumbar puncture in the paediatric population, but remains to be validated.

A Randomized Study to Validate a Midspinal Canal Depth Nomogram in Neonates

American Journal of Perinatology, 2009

Improving the accuracy of lumbar puncture (LP) in neonates should reduce the incidence of hemorrhagic contamination of cerebrospinal fluid (CSF) samples. We have previously demonstrated a linear correlation between neonatal weight and midspinal canal depth (MSCD), generating a nomogram and simple formula to allow MSCD estimation. In this study, we attempted to validate the nomogram by improving the quality of the CSF samples obtained. We consecutively randomized 99 infants in whom LP was clinically warranted to receive either a standard, ''blind'' (n ¼ 48) or ''measured'' (n ¼ 51) procedure. If allocated to the measured technique, the operator marked the LP needle with a Steri-Strip TM at the predicted depth of insertion (i.e., MSCD) derived from the weight-based nomogram. CSF samples were classified as clear (<500 red blood cells [rbc]/mL), mildly bloodstained (500 to 10,000 rbc/mL), heavily bloodstained (>10,000 rbc/mL or clotted), or failed procedures. Clear and mildly bloodstained LPs were ''successful.'' Heavily bloodstained or failed procedures were considered ''unsuccessful.'' We also recorded the number of attempts required to obtain a CSF sample. The overall success rate ( 10,000 rbc/mL) in this study was 56/99 (56.6%). There was no significant difference in success rates in the measured group (32/51, 62.7%) when compared with the blind group (24/48, 50%; chi-square ¼ 1.143, p ¼ 0.072). Success rates were higher for less experienced (Resident) doctors (62.8% versus 45.0%; chi-square ¼ 0.51, p ¼ 0.047) and in the premature (28 to 37 weeks' gestation) group (80.0% versus 37.5%; chi-square ¼ 2.66, p ¼ 0.007). Overall success rates dropped with each consecutive LP attempt (first, 39/52, 75.0%; second, 11/22, 50.0%; third, 5/16, 31.3%), and no fourth or fifth attempts were successful. The nomogram did not significantly improve overall LP success rates in this cohort of patients. However, using the measured technique, LPs performed by less experienced doctors and those performed in the premature (28 to 37 weeks' gestation) group were more successful than those performed using the blind technique. The measured technique has the potential to be a useful tool for doctors in the early stages of their training. Furthermore, we advocate no more than three LP attempts in this population to avoid prolonging discomfort and increasing the risk of physiological compromise to the neonate.

Population reference range for developmental lumbar spinal canal size

Quantitative imaging in medicine and surgery, 2016

Considerable variability exists in normal developmental lumbar spinal canal size. This impacts the likelihood of neural compromise. Spinal canal development is complete by 17 years. As diseases incurred thereafter do not knowingly affect the developmental size of the spinal canal, it is reasonable to use a selected population undergoing abdominopelvic computed tomography (CT) examination to determine developmental lumbar spinal canal size. Study approval was granted by the Clinical Research Ethics Committee. Between Feb 2014 and Jan 2015, mid-vertebral spinal canal cross-sectional area (CSA), depth, width, and vertebral body CSA at each level from L1-L5 was measured, using a semi-automated computerized method in 1,080 ambulatory patients (540 males, 540 females, mean age, 50.5±17 years). Patient height and weight was measured. A reference range for developmental lumbar spinal canal dimensions was developed at each lumbar level for each sex. There was a 34% variation in spinal canal ...