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DOI: 10.1055/s-2007-963052
© Georg Thieme Verlag KG Stuttgart · New York
Spinal Sonography in Newborns and Infants - Part I: Method, Normal Anatomy and Indications
Spinale Sonografie im Neugeborenen- und Säuglingsalter - Teil I: Methode, normale Anatomie und IndikationenPublikationsverlauf
received: 25.9.2006
accepted: 14.2.2007
Publikationsdatum:
09. Mai 2007 (online)

Zusammenfassung
Bei Neugeborenen und Säuglingen kann das Rückenmark sonografisch untersucht werden, da die Wirbelbögen noch nicht vollständig ossifiziert sind. Mit hochauflösenden Linearschallköpfen (> 10 MHz) kann der Spinalkanal mit vorzüglicher Bildqualität von der Schädelbasis bis zu seinem kaudalen Ende dargestellt werden. Routinemäßig werden Sagittal- und Axialschnitte durchgeführt. Neben dem Rückenmark können die Nervenwurzeln und die Cauda equina sowie der Konusstand ermittelt werden. Normalerweise endet der Conus medullaris oberhalb von L2/L3. Tiefere Positionen sprechen für das Vorliegen eines tethered cord. Mit der M-Mode-Sonografie können die normalen Oszillationen des Rückenmarks, die durch Atembewegungen und Herzaktionen zustande kommen, dargestellt werden. Mit der farbkodierten Doppler-Sonografie können der epidurale Venenplexus und die Rami centrales der A. spinalis anterior dargestellt werden. Normvarianten sind eine transiente Erweiterung des Zentralkanals, ein Ventriculus terminalis sowie ein asymmetrischer Ursprung der Nervenwurzeln. Indikationen zur spinalen Sonografie sind lumbosakrale kutane Marker, subkutane Weichteilschwellungen, Fußfehlbildungen, anorektale und urogenitale Fehlbildungen sowie neurologische Auffälligkeiten der unteren Extremität. Alle genannten klinischen Symptome sind verdächtig auf das Vorliegen einer okkulten spinalen Dysrhaphie und eines tethered cord, die durch eine rechtzeitig durchgeführte spinale Sonografie ausgeschlossen werden sollten.
Abstract
Spinal sonography can be performed in newborns and young infants as long as the vertebral arches are not completely ossified. With high resolution linear transducers (> 10 MHz), excellent detailed images of the spine may be obtaind from the base of the skull to the caudal end of the thecal sac. Sagittal and axial sections are performed routinely. Beside the spinal cord, the dorsal and ventral nerve roots and the cauda equina can be shown. The medullary conus normally ends above the level of L2/L3. Lower positions are suspective of tethered cord. M-mode sonographic examinations reveal oscillations of the cord due to respiration and the pulse cycle. Colour Doppler sonography displays the epidural venous plexus as well as the central branches of the anterior spinal artery. Normal variants are transient widening of the central canal, terminal ventricle and asymmetric nerve roots. Indications for spinal sonography are midline cutaneous markers in the lumbosacral region, subcutaneous masses, foot abnormalities, anorectal and genitourinary malformations and neurological abnormalities of the lower extremities. All these clinical symptoms are suspicious of spina bifida occulta and tethered cord which should be ruled out by spinal sonography.
Key words
spinal cord - normal variants - ultrasound 2D - infants - indications
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Prof. Karl-Heinz Deeg
Sozialstiftung Bamberg, Klinik für Kinder- und Jugendmedizin
Buger Str. 80
96049 Bamberg
Telefon: ++49/951/5032701
Fax: ++49/951/503270 5
eMail: karl-heinz.deeg@sozialstiftung-bamberg.de