Pediatric Spine

Protocol
Prone position over rolled up towel with knees tucked under abdomen
Examination is typically limited to the lumbosacral region
Use a high-frequency linear transducer (8-15 MHz)
Best to perform the exam after a feeding and using warm gel
Determine vertebral body levels prior to storing any images
o Identify the 5 straight lumbar vertebrae superior to the 5 curved sacral vertebrae
o Identify the hypoechoic coccyx inferior to the sacrum (the 1 st coccygeal segment
is typically not ossified at birth, but if it is, it will be more round than the square
to rectangular sacral bodies)
o Identify T12 by angling laterally to find the lowest rib, then scan medially

Organ/Ord Scan Label Landmarks Identified

er Plane
Spinal cord
SAG SPINE
Subarachnoid space/ CSF
T-12
Vertebral bodies
L-1
Conus medullaris (should be at or above the
L-2
L2 to L3 disk space should not extend to L-
L-3
3)
Spinal cord
SAG SPINE
Vertebral bodies
L-2
Conus medullaris
Sagittal L-3
Cauda equina
(label each L-4
Filum terminale (should be < 2 mm in
vertebra L-5
thickness)
on the
SAG SPINE Vertebral bodies
image)
L-4 Thecal sac
L-5
S-1
Spinal
S-2
Cord
SAG SPINE Sacrum
S-3 Coccyx
S-4 Rectum
S-5
TX SPINE Spinal cord
L-1 Subarachnoid space/ CSF
Vertebral bodies
TX SPINE Conus medullaris
L-2 Subarachnoid space/ CSF
Transverse
Vertebral bodies
(label the
TX SPINE Cauda equina
Right side
L-3 Filum terminale
on the
Subarachnoid space/ CSF
image)
Vertebral bodies
TX SPINE Cauda equina
L-4 Filum terminale
Subarachnoid space/ CSF
Vertebral bodies
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 Pediatric Spine

Anatomical/Image Correlation

Documentation
Level of conus medullaris
Position of spinal cord in spinal canal
Cord and nerve root motion
Any cutaneous lesions or vertebral body deformities

Tips
Sonography is not useful in infants older than 6 months due to ossification of the posterior
spinous processes
Spinal abnormalities are associated with kidney abnormalities patient history is important
Clinical indications include:
o Evaluation of spinal dysraphism and any associated mass
o Lumbosacral skin anomalies evaluating for an associated tethered cord
o Acquired lesions
o Evaluating for hematoma following a spinal tap or traumatic delivery
If there is any question about the vertebral levels, speak to the radiologist about doing an X-
ray a radiopaque marker (BB) can be placed at the level of the conus medullaris using
sonographic guidance prior to the X-ray this will confirm the vertebral body levels/ location
of the conus
If there is a tract visualized, it is important to determine if the tract extends to the actual spinal
canal (dorsal dermal sinus) or to the coccyx (pilonidal sinus)
If the filum terminale appears thickened and/or echogenic, obtain an AP measurement of it
normal measurement is less than 2 mm

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