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This article reviews the indications, techniques, and sonographic features of congenital and acquired spinal pathologies in neonates. Common indications include the evaluation of atypical sacral dimples, spinal anomalies such as tethered cord and syringomyelia, congenital tumours like sacrococcygeal teratomas, and post-traumatic conditions such as spinal hematomas. Detailed sonographic spine anatomy, variants, and ultrasound guidance for interventions like lumbar puncture are also discussed. 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