Skin Markers of Occult Spinal Dysraphism in Children

S PINAL DYSRAPHISM REFERS TO a spectrum of congenital anomalies characterized by an incomplete fusion of the midline mesenchymal, bony, or neural elements of the spine. As skin and nervous tissue are of ectodermal origin, anomalies of both may occur simultaneously. Occult spinal dysraphism (OSD) is characterized by skin-covered lesions without exposed neural tissue. Congenital midline paraspinal lesions, mostly localized in the lumbosacral area, are widely recognized as markers of OSD. They include subcutaneous lipomas, dermal sinuses, tails, and localized hypertrichosis. In the presence of such cutaneous lesions, radiologic investigations must be performed to detect a possible OSD. Hyperpigmented lesions and aplasia cutis congenita are also reported to be associated with OSD. The screening value of isolated lumbosacral vascular lesions remains difficult to determine because, despite the International Society for the Study of Vascular Anomalies (ISSVA) classification, ambiguity persists in the terminology used in the literature. At present, the importance of dimples is still under discussion. Furthermore, no one has established whether isolated deviation of the gluteal furrow (DGF) represents a cutaneous marker of OSD.