Skin lesions of the spinal axis and spinal dysraphism

Objective: To catalog the paraspinal skin lesions of early childhood that are associated with occult spinal dysraphism. Research Design: Retrospective review of a series of patients. Setting: Tertiary care referral center. Patients: Fifteen patients who had significant paraspinal skin lesions were identified from the personal files of the authors who saw them. Results: The skin lesions included various combinations of hyperpigmentation, hypopigmentation, hypertrichosis, acrochordons, dimples, lipomas, hemangiomas, or teratomas. Not all lesions were evaluated with the same tests, which included plain roentgenography, ultrasonography, myelography, computed tomography, and magnetic resonance imaging. Of the 15 patients, six had spinal anomalies, eight had no apparent spinal dysraphism, and one had insufficient results of the evaluation to assess the spinal column. Conclusions: Early recognition of paraspinal skin lesions is essential to prevent neurologic damage. Urinary or fecal incontinence, recurrent urinary infections, muscle atrophy, foot deformities, weakness, pain, or decreased sensation in the lower extremities may eventually develop in these patients. Magnetic resonance imaging appears to be the single best screening test for dysraphism. (Arch Pediatr Adolesc Med. 1994;148:740-748)
Children with skin lesions over the spine should undergo radiologic study of the spinal column because skin lesions may signal abnormalities of the spinal cord. Early recognition and treatment can avert neurologic problems. Skin lesions occur during pregnancy when the back of the embryo fails to fuse properly. The types of skin lesions that should be imaged include benign fat cell tumors, abnormal hairy patches, deep dimples and sinuses, hemangiomas and telangiectases (lesions formed by abnormal blood vessel clusters), dark skin pigmentation or no pigmentation, skin tags and tails, and teratomas (mixed cell tumors that may become malignant) and neurofibromas (benign nerve cell tumors). Fifteen patients with skin lesions are described, of whom six had underlying defects of the spinal column.