Evaluation and Management of Spinal Dysraphism

Introduction to Spinal Dysraphism

The American Academy of Pediatrics recommends that a patient presenting with day and night enuresis, chronic constipation, and a sacral dimple should undergo lumbar spine MRI immediately to evaluate for spinal dysraphism and tethered cord syndrome, as this combination of symptoms strongly suggests an underlying spinal cord abnormality 1
A sacral dimple located above the imaginary line drawn between the tops of the gluteal cleft is considered a lumbosacral dermal sinus tract and requires further evaluation, as this location significantly increases the risk of underlying spinal cord pathology 1

MRI is specifically indicated when there are associated markers of dysraphism, bowel and bladder dysfunction, or lower limb upper motor neuron signs, and this patient meets multiple criteria with both urinary and bowel dysfunction 1
Potential complications of untreated pathologic dermal sinus tracts include CNS infection, aseptic meningitis, spinal cord compression, and neurologic deterioration from tethering, making early detection crucial to prevent irreversible neurological damage 1

The combination of day and night enuresis with constipation in the context of a sacral dimple suggests neurogenic bladder and bowel dysfunction rather than simple functional constipation, according to the American Urological Association 2
Spinal ultrasonography is recommended as the initial imaging study for infants under 6 months of age, but MRI provides superior visualization of spinal cord pathology, including tethered cord, lipomas, and other dysraphic lesions, especially in older patients 1

Patients with spina bifida and related spinal dysraphism often require lifetime catheterization, and early diagnosis allows for timely neurosurgical intervention to prevent further neurological deterioration, appropriate urological management to preserve renal function, establishment of bowel management programs, and prevention of complications including recurrent UTIs, hydronephrosis, and renal damage, as recommended by the American Urological Association 2
Urodynamic studies are premature before structural spinal pathology has been excluded or confirmed, but are appropriate after anatomical evaluation to characterize the functional impact of neurogenic bladder, according to the International Children's Continence Society 2