ABSTRACT
Figure 1 Composite longitudinal sonogram of the low thoracic to mid-lumbar spinal canal (patient’s head is to the left). The caudal end of the spinal cord (open arrowheads) widens above the tapered conus medullaris (wavy arrow). The central echo complex in the center of the cord appears as two parallel lines (small arrowheads). Straight arrows, dura; V, vertebral body (only two are labelled); CE, cauda equina
Figure 3 Detailed off midline longitudinal view which shows lamina (curved arrows) resembling overlapping roof tiles
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Figure 2 Composite longitudinal sonogram of the lumbo-sacral spinal canal showing the conus tip (wavy arrow) and echogenic roots of the cauda equina. Patient’s head is to the left. Straight arrow, caudal end of the thecal sac; V, vertebral body (only two are labelled)
Figure 4 Longitudinal view of the normal neonatal sacrum showing the ‘stepwise’ dorsal progression of the ossified sacral vertebral body segments (straight arrows) and the unossified coccyx (curved arrows)
Figure 5 (a-e) The normal spinal cord at various levels. Note the central echo complex in the middle of the cord appearing as a line in the longitudinal views and as a dot in the transverse views. L, lamina; V, vertebral body; T, thoracic vertebral body; sp, spinous process; small arrowheads, dura, (a) Transverse cervical cord (high lighted by wavy arrows), (b) Transverse thoracic cord (highlighted by wavy arrows). Note how it is in the ventral aspect of the canal and smaller in diameter than the cervical or lumbar cord, (c) Longitudinal thoracic cord (highlighted by open arrowheads). The dura (arrows in this example) appears as thick echogenic bands along the canal. (d) Transverse lumbar cord (wavy arrow), (e) Longitudinal low thoracic-lumbar cord (highlighted by arrows). Note the tapered conus medullaris
Figure 6 Transverse view showing dentate ligaments (arrowheads) extending from the thoracic cord. V, vertebral body
Figure 9 Transverse view of the low lumbar canal in another infant showing cauda equina as bilateral clusters of nerve roots (arrows). V, vertebral body
Figure 7 Transverse views at the level of the conus on a split screen. The left frame shows the conus surrounded by echogenic dorsal and ventral roots of the cauda equina (ce). At the very tip of the conus (right frame) the dorsal and ventral roots have a ‘spiderlike’ or ‘wavy X ’ configuration. V, vertebral body; arrowheads, dura
Figure 10 Transverse view of the low lumbar canal showing cauda equina (ce) as bilateral clusters of nerve roots in an inverted ‘V’ configuration. Arrow, dorsal dura; V, vertebral body
Figure 8 Transverse view of the low lumbar canal showing cauda equina as bilateral clusters of nerve roots (arrows). V, vertebral body
Figure 11 Transverse view of the tip of the conus medullaris. Dorsal and ventral nerve roots (white arrows) have a ‘spiderlike’ or ‘wavy X ’ configuration. Note the vague ‘similarity’ to Figure 12. Black arrows, dorsal dura; V, vertebral body
Figure 12 Transverse view of diastematomyelia. The septum traversing the spinal cord is not visible at this level, although the two hemicords (H) are clearly shown. Arrows, dorsal dura; V, vertebral body
Figure 13 Longitudinal split screen composite view of the lumbosacral canal. The caudal end of the thecal sac (wavy arrow) usually corresponds to S2. L, lumbar vertebral bodies; S, sacral vertebral bodies
Figure 14 Longitudinal split screen showing a method of estimating the vertebral level of the conus tip (wavy arrow). Left frame identifies the lowest rib (straight arrow) over the kidney (K). In the right frame the rib is sonographically followed back to the vertebral column to presumably locate T12. Note the two minimally separated parallel lines extending longitudinally down the middle of the cord, the central echo complex
Figure 15 (a) Hypoplastic vertebral body. Antero posterior projection (AP) radiograph showing the hypoplastic left portion of L3 vertebral body (arrow). T 12, vertebral body 12th thorax; L5, vertebral body 5th lumbar, (b) Hypoplastic vertebral body. Split screen composite longitudinal sonogram of the lumbosacral canal. The hypoplastic mid-lumbar vertebral body (small straight arrow) is noted in contrast to the other lumbar vertebral bodies (V). Incidental note is made of two minimally separated lines in the middle of the cord (small arrowhead) which constitute the central echo complex. Wavy arrow, tip of normal conus; large straight arrow, caudal tip of thecal sac
Figure 16 (a-g) Spinal cord tethered by a lipoma in the low lumbar canal shown on sonography and MRI. (a) Transverse mid-lumbar cord, cephalad to the tethering. V, vertebral body, (b) Longitudinal lower thoracic - upper lumbar cord (arrowheads) cephalad to the tethering, (c) Longitudinal view of the mid-lumbar cord (arrowheads), cephalad to the tethering. Note that the cord is extending dorsally as well as caudally. Wavy arrows, spinous processes, (d) Transverse view of the low lumbar canal showing the cord (arrowheads) tethered dorsally and caudally by an intracanalicular lipoma (L) on its right, (e) Transverse MRI of the low lumbar canal in same orientation as sonogram (i.e. dorsal is up) showing the cord (arrowheads) tethered dorsally and caudally by an intracanalicular lipoma (L) on its right, (f) Sagittal MRI of lumbosacral canal showing cord (arrowheads) tethered at the lumbosacral junction by a lipoma (L) which extends from the subcutaneous tissues to the spinal cord, (g) Sagittal sonogram of the cord (white arrowheads) tethered in the low lumbar canal by the lipoma (black arrowheads). V, vertebral bodies
Figure 17 A segmented longitudinal view showing hydromyelia as wide separation of the central echoes (arrowheads) in the central portion of the cord (arrows), d, dura; V, vertebral bodies
Figure 18 Longitudinal (a) and transverse (b) segmental views (obtained between shadowing posterior elements) of a hydromyelic spinal cord. Arrowheads, dorsal and ventral cord margins; double headed arrows, hydromyelia; D, dorsal dura; V, vertebral body
Figure 19 (a-e) Filar cyst and thick filum terminale. V, vertebral bodies, (a) Longitudinal view of the tapering cord and conus medullaris (arrows) with a large cyst (double headed arrows) of the filum terminale. (b) Transverse view of the normal conus medullaris (arrows). N, dorsal nerve roots, (c) Transverse view of the cyst at the filum (double headed arrow), (d) Longitudinal view of the cyst (double headed arrow) and the thick filum terminale (*). (e) Transverse view of the thick echogenic filum terminal (*). L, lamina
Figure 20 (a-c) Thin walled extramedullary cyst (arrows) on the dorsum of the low thoracic cord. Note how it slightly flattens the dorsal surface of the cord, (a) Sonogram; split screen (transverse view on left; longitudinal on right), (b) Transverse MRI. (c) Longitudinal MRI
Figure 21 (a-d) Newborn with an unrepaired myelomeningocele, (a) and (b) Longitudinal (a) and transverse (b) views of lower cord (arrowheads) entering the dorsal sac. Note the increased echogenicity of the portion of the cord which extends into the sac. Wavy arrows, nerve roots (not all are labelled); V, vertebral bodies. H arrow points cephalad.(c) Transverse view of nerve roots (wavy arrows) extending ventrally from the neural placode in the dorsal, caudal aspect of the sac. V, vertebral body, (d) Longitudinal view of nerve roots (wavy arrows) extending ventrally and slightly cephalad from the dorsal, caudal aspect of the sac. S, sacral vertebral bodies
Figure 22 Sagittal view of an unrepaired neonatal meningocele. Note how empty it is. V, vertebral body
Figure 23 Transverse view of the lumbar cord at the level of an unrepaired meningocele in a newborn. The spinal cord (black arrowheads) is within the spinal canal. In this case the shape of the cord is distorted dorsally by strands of lace-like pia-arachnoid (white arrow) which extend dorsally into the meningocele
Figure 24 Midline sagittal cranial sonogram obtained through the anterior fontanelle of a newborn with myelomeningocele and a Chiari II (i.e. Arnold-Chiari) malformation. The cerebellum (CB) is low, abutting the floor of the posterior fossa (arrows) and obliterating the cisterna magna. M, prominent interthalamic massa intermedia
Figure 25 Sagittal (a) and transverse (b) views of a normal upper cervical canal at the foramen magnum. CB, cerebellum; CM, cisterna magna; M, medulla; C, cervical cord
Figure 26 Sagittal (a) and transverse (b) views of the cervical spinal canal in a patient with Chiari II malforma tion which were obtained through the intact skin and spine. Thick arrowheads, caudally displaced thick vermian peg; thin arrowheads, caudally displaced medulla and cervical cord; curved arrow, cervicomedullary kink; V, cervical vertebral bodies
Figure 27 Sagittal MRI of a Chiari II malformation. The vermian peg (arrows) extends through the foramen magnum into the upper cervical canal, cb, cerebellum; H, hydromyelia of the thoracic cord
Figure 28 Longitudinal (a) and transverse (b) intraoperative views of a Chiari II malformation showing echogenic, dysplastic, caudally displaced vermian peg (VP) dorsal to the medulla and cervical cord (C). The dura (arrows) is intact
Figure 29 Sagittal sonogram (a) and MRI (b) showing a sinus tract (small arrows) dorsal to the sacral canal. Broad arrow, tip of the conus medullaris; V, vertebral bodies
Figure 30 (a-d) Normal unossified coccyx (arrows) obtained through a stand-off pad. (a) Sagittal view of coccyx and ossified sacral elements (S). (b), (c) and (d) Transverse views of the coccyx in descending order. The most cephalad portion (b) includes the last sacral ossific nucleus. The most caudal portion (d) is right under the skin
Figure 31 Frontal radiograph of an infant with an anterior meningocele and a crescentic scimitar sacrum (arrowheads)
Figure 32 Longitudinal (a) and transverse (b) views of a presacral cyst (curved arrows). S, sacral vertebral bodies; C, coccyx; broad arrow, air which had been instilled into the rectum for localization
Figure 33 Longitudinal view of the caudal aspect of the sacrum showing a low tethered spinal cord (arrows) and an anterior, pre-sacral meningocele (me). S, sacral vertebral elements; H, cephalod direction
Figure 34 Frontal radiograph shows widened interpediculate distance (arrow) in a patient with a posterior sacral myelomeningocele. A meningocele or a lipomyelomeningocele could have a similar appearance
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