PROSPECTIVE EVALUATION OF ABNORMALITIES OF THE CRANIOSPINAL AXIS (CSA) IN NEWBORNS

Abstract

A review of the literature revealed 104 cases with dermal defects distributed along the CSA (59% lumbar or lower and 31% occipital). Although at least 41 patients had lesions noted as newborns, only 20 patients were operated on before becoming infected. Ten of the affected children died and 32 had neurologic residua; none of 20 children operated on before becoming infected died or had residua. Adequate incidence and treatment data could not be determined.

Term infants born at the UCLA Hosp. from Sept. 1 - Dec. 31, 1973 were examined for abnormalities of the CSA. The CSA of each infant was palpated and inspected (in good light, parting the scalp hair, and using magnification when necessary) from the bridge of the nose bo the anus. Suspicious lesions were photographed, and roentgenographs obtained for presumed sinuses and other selected lesions. One or more suspicious finding was seen in 39 (4.2%) of 834 neonates. These included 16 (1.9%) deep dimples (bottom seen); 14 (1.7%) presumed sinuses (bottom not seen); 6 (.7%) masses; 3 (.35%) skin tags; 2 (.22%) discolorations; and 1 (.12%) abnormal hair. All lesions but one were lumbar or lower. Incidence by sex was equal, and no roentgenographic abnormalities were found.

The results show an alarmingly high incidence of abnormalities of the CSA with a surprising paucity of occipital lesions. The significance of these lesions remains to be defined by careful follow-up and surgery in selected cases.

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