Patient selection: one or more midline lumbosacral lesions with no exposure of neural tissue
Types of lesions:
(1) lipoma
(2) tail
(2a) human tail = a cylindrical neuroectodermal appendage
(2b) faun tail = congenital midline lumbosacral tuft of abnormal hair
(3) dermal sinus
(4) atypical dimple (one or more of the following: > 5 mm in diameter, > 2.5 cm from anus, in combination with other lesions)
(5) simple dimple (isolated small lesion <= 5 mm in diameter and <= 2.5 cm from the anus)
(6) unclassified hamartoma
(7) aplasia cutis congenita (defect in skin either (a) covered by membrane, scar tissue or granulation tissue, or (b) raw or ulcerated)
(8) deviation of gluteal furrow
(9) hemangioma
(10) port wine spot
(11) hypertrichosis (excess normal hair over the lumbosacral region)
(12) pigmented nevus
(13) Mongolian spot
Criteria for high risk group:
(1) 2 or more lesions of any type
(2) 1 lesion of any type plus spinal cord dysfunction
(3) presence of one of the following:
(3a) lipoma
(3b) tail
(3c) dermal sinus
Criteria for moderate risk group - presence of one of the following:
(1) atypical dimple
(2) unclassified hamartoma
(3) aplasia cutis congenita
(4) deviation of gluteal furrow
Criteria for low risk group - presence of one of the following:
(1) hemangioma
(2) port wine spot
(3) hypertrichosis
(4) pigmented nevus/lesion (to include lentigo and café au lait spot)
(5) simple dimple
(6) Mongolian spot
Recommended workup:
(1) No imaging studies are required for a child in the low risk group.
(2) Ultrasound is done on a child in the moderate risk group who is < 6 months of age. If normal then no further imaging studies are required.
(3) MRI is done on a child
(3a) in the high risk group
(3b) in the moderate risk group < 6 months of age with abnormal ultrasound
(3c) in the moderate risk group >= 6 months of age
