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Fifteen Cases and a Review of the Literature

Jean McAtee-Smith, MD; Adelaide A. Hebert, MD; Ronald P. Rapini, MD; Neil S. Goldberg, MD

Arch Pediatr Adolesc Med. 1994;148(7):740-748.

Abstract
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)

Author Affiliations
From the Departments of Dermatology (Drs McAtee-Smith, Hebert, and Rapini), Pediatrics (Dr Hebert), and Pathology (Dr Rapini), The University of Texas–Houston Medical School, and the Department of Dermatology, New York Medical College, Valhalla (Dr Goldberg). Dr Rapini is currently with the Department of Dermatology, Texas Tech University, Lubbock.

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