{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T15:00:37Z","timestamp":1781190037056,"version":"3.54.1"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,13]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Spinal ultrasound is used to investigate occult dysraphism in neonates with sacrococcygeal dimples. Inappropriate imaging studies may be performed despite the Choosing Wisely Canada guidelines. The objective of this study was to assess the appropriateness of spinal ultrasounds performed in 2 Canadian provinces and to compare the diagnostic accuracy of spinal ultrasound and MRI in predicting the need for neurosurgical intervention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This multicenter retrospective cohort study identified spinal ultrasounds in neonates younger than 6 months of age from January 1, 2017, to December 30, 2018, in Alberta and British Columbia, Canada. The authors collected data on patient demographic characteristics, reasons for requested imaging, the presence of any imaging abnormalities, and the ultimate need for intraspinal surgery. Ultrasounds were deemed appropriate if the Choosing Wisely guidelines were followed for ordering. The authors compared high-risk findings on spinal ultrasound and MRI to the need for surgery using sensitivities, specificities, positive predictive values (PPV), and negative predictive values (NPV).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A total of 1043 ultrasounds were ordered in 1042 neonates, most commonly by pediatricians (49%), family doctors (27%), and neonatologists (16%). Three hundred eighty-three ultrasounds (37%) were deemed inappropriately ordered. Sixty-nine infants (7%) of the cohort received an MRI and 11 (1%) ultimately underwent neurosurgical intervention. None of the patients who had an inappropriately ordered ultrasound underwent surgery. Spinal ultrasound, compared to surgery, had a sensitivity of 36%, specificity of 98%, PPV of 17%, and NPV of 99%. Spinal MRI, compared to surgery, had a sensitivity of 73%, specificity of 76%, PPV of 38%, and NPV of 94%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Although spinal ultrasound has an acceptable specificity in predicting surgery, it remains a poor screening test (36% sensitivity). Given that approximately 37% of spinal ultrasounds were inappropriately ordered in this study period, the authors estimate that if physicians followed the Choosing Wisely Guidelines more closely, it would result in an estimated potential cost savings of CAD$1,856,769 over a decade for Canada with minimal surgical impact and a very low risk of missing surgically relevant spinal dysraphism.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.10.peds25213","type":"journal-article","created":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T02:10:13Z","timestamp":1771035013000},"page":"402-408","source":"Crossref","is-referenced-by-count":0,"title":["\u201cInappropriate\u201d spinal ultrasounds for suspected occult spinal dysraphism"],"prefix":"10.3171","volume":"37","author":[{"given":"Nicholas","family":"Sader","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Oklahoma University College of Medicine, Oklahoma City, Oklahoma;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brij S.","family":"Karmur","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Calgary, Alberta, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael B.","family":"Keough","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harjot","family":"Uppal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, BC Children\u2019s Hospital, Vancouver, British Columbia, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Watson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, BC Children\u2019s Hospital, Vancouver, British Columbia, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrienne","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandeep S.","family":"Tamber","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, BC Children\u2019s Hospital, Vancouver, British Columbia, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vivek","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Riva-Cambrin","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurosciences, University of Calgary, Alberta, Canada;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Can J Neurol Sci","first-page":"736","article-title":"Embryology of spinal dysraphism and its relationship to surgical treatment","volume":"47","author":"Eagles ME","year":"2020","unstructured":"Eagles ME, Gupta N. Embryology of spinal dysraphism and its relationship to surgical treatment. Can J Neurol Sci. 2020;47(6):736\u2013746. doi:10.1017\/cjn.2020.75"},{"issue":"6","key":"b2","series-title":"AJR Am J Roentgenol","first-page":"1687","article-title":"Occult spinal dysraphism in neonates: assessment of high-risk cutaneous stigmata on sonography","volume":"171","author":"Kriss VM","year":"1998","unstructured":"Kriss VM, Desai NS. Occult spinal dysraphism in neonates: assessment of high-risk cutaneous stigmata on sonography. AJR Am J Roentgenol. 1998;171(6):1687\u20131692. doi:10.2214\/ajr.171.6.9843314"},{"issue":"5","key":"b3","series-title":"Pediatrics","first-page":"E69","article-title":"Coccygeal pits","volume":"105","author":"Weprin BE","year":"2000","unstructured":"Weprin BE, Oakes WJ. Coccygeal pits. Pediatrics. 2000;105(5):E69. doi:10.1542\/peds.105.5.e69"},{"issue":"2","key":"b4","series-title":"HK J Paediatr","first-page":"93","article-title":"Management of sacral dimples detected on routine newborn examination: a case series and review","volume":"12","author":"Lee ACW","year":"2007","unstructured":"Lee ACW, Kwong NS, Wong YC. Management of sacral dimples detected on routine newborn examination: a case series and review. HK J Paediatr. 2007;12(2):93\u201395."},{"issue":"3","key":"b5","series-title":"Pediatr Ann","first-page":"95","article-title":"The enigmatic sacro-coccygeal dimple: to ignore or explore?","volume":"43","author":"Block SL","year":"2014","unstructured":"Block SL. The enigmatic sacro-coccygeal dimple: to ignore or explore? Pediatr Ann. 2014;43(3):95\u2013100. doi:10.3928\/00904481-20140221-04"},{"issue":"3","key":"b6","series-title":"Pediatr Rev","first-page":"109","article-title":"Sacral dimples","volume":"32","author":"Zywicke HA","year":"2011","unstructured":"Zywicke HA, Rozzelle CJ. Sacral dimples. Pediatr Rev. 2011;32(3):109\u2013114,151. doi:10.1542\/pir.32-3-109"},{"issue":"2","key":"b7","series-title":"Pediatr Radiol","first-page":"211","article-title":"The simple sacral dimple: diagnostic yield of ultrasound in neonates","volume":"45","author":"Kucera JN","year":"2015","unstructured":"Kucera JN, Coley I, O\u2019Hara S, Kosnik EJ, Coley BD. The simple sacral dimple: diagnostic yield of ultrasound in neonates. Pediatr Radiol. 2015;45(2):211\u2013216. doi:10.1007\/s00247-014-3110-1"},{"issue":"8","key":"b8","series-title":"Acta Paediatr","first-page":"890","article-title":"Spine ultrasounds should not be routinely performed for patients with simple sacral dimples","volume":"105","author":"Albert GW","year":"2016","unstructured":"Albert GW. Spine ultrasounds should not be routinely performed for patients with simple sacral dimples. Acta Paediatr. 2016;105(8):890\u2013894. doi:10.1111\/apa.13422"},{"key":"b9","article-title":"Pediatric Neurosurgery - Five Tests and Treatments to Question. Choosing Wisely Canada","unstructured":"Pediatric Neurosurgery - Five Tests and Treatments to Question. Choosing Wisely Canada. Accessed November 18, 2025. https:\/\/choosingwiselycanada.org\/recommendation\/pediatric-neurosurgery\/?highlight=pediatric\u00b1neurosurgery"},{"issue":"6","key":"b10","series-title":"Paediatr Child Health","first-page":"383","article-title":"Choosing Wisely Canada: pediatric neurosurgery recommendations","volume":"23","author":"Radic JAE","year":"2018","unstructured":"Radic JAE, Cochrane DD. Choosing Wisely Canada: pediatric neurosurgery recommendations. Paediatr Child Health. 2018;23(6):383\u2013387. doi:10.1093\/pch\/pxy012"},{"issue":"1","key":"b11","series-title":"Australas J Ultrasound Med","first-page":"39","article-title":"Ultrasound examination of the neonatal spine","volume":"14","author":"Fitzgerald K","year":"2011","unstructured":"Fitzgerald K. Ultrasound examination of the neonatal spine. Australas J Ultrasound Med. 2011;14(1):39\u201341. doi:10.1002\/j.2205-0140.2011.tb00186.x"},{"issue":"12","key":"b12","series-title":"Childs Nerv Syst","first-page":"1719","article-title":"International survey on the management of skin stigmata and suspected tethered cord","volume":"26","author":"Ponger P","year":"2010","unstructured":"Ponger P, Ben-Sira L, Beni-Adani L, Steinbok P, Constantini S. International survey on the management of skin stigmata and suspected tethered cord. Childs Nerv Syst. 2010;26(12):1719\u20131725. doi:10.1007\/s00381-010-1184-0"},{"issue":"3","key":"b13","series-title":"J Neurosurg Pediatr","first-page":"274","article-title":"Use of lumbar ultrasonography to detect occult spinal dysraphism","volume":"9","author":"Chern JJ","year":"2012","unstructured":"Chern JJ, Kirkman JL, Shannon CN,  Use of lumbar ultrasonography to detect occult spinal dysraphism. J Neurosurg Pediatr. 2012;9(3):274\u2013279. doi:10.3171\/2011.12.PEDS11351"},{"issue":"2","key":"b14","series-title":"Childs Nerv Syst","first-page":"285","article-title":"Occult spinal dysraphisms in newborns with skin markers: role of ultrasonography and magnetic resonance imaging","volume":"34","author":"Ausili E","year":"2018","unstructured":"Ausili E, Maresca G, Massimi L, Morgante L, Romagnoli C, Rendeli C. Occult spinal dysraphisms in newborns with skin markers: role of ultrasonography and magnetic resonance imaging. Childs Nerv Syst. 2018;34(2):285\u2013291. doi:10.1007\/s00381-017-3638-0"},{"issue":"7","key":"b15","series-title":"JAMA Netw Open","first-page":"e207221","article-title":"Incidence of occult spinal dysraphism among infants with cutaneous stigmata and proportion managed with neurosurgery: a systematic review and meta-analysis","volume":"3","author":"Choi SJ","year":"2020","unstructured":"Choi SJ, Yoon HM, Hwang JS,  Incidence of occult spinal dysraphism among infants with cutaneous stigmata and proportion managed with neurosurgery: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(7):e207221. doi:10.1001\/jamanetworkopen.2020.7221"},{"issue":"6","key":"b1","series-title":"Can J Neurol Sci","first-page":"736","article-title":"Embryology of spinal dysraphism and its relationship to surgical treatment","volume":"47","author":"Eagles ME","year":"2020","unstructured":"Eagles ME, Gupta N. Embryology of spinal dysraphism and its relationship to surgical treatment. Can J Neurol Sci. 2020;47(6):736\u2013746. doi:10.1017\/cjn.2020.75"},{"issue":"6","key":"b2","series-title":"AJR Am J Roentgenol","first-page":"1687","article-title":"Occult spinal dysraphism in neonates: assessment of high-risk cutaneous stigmata on sonography","volume":"171","author":"Kriss VM","year":"1998","unstructured":"Kriss VM, Desai NS. Occult spinal dysraphism in neonates: assessment of high-risk cutaneous stigmata on sonography. AJR Am J Roentgenol. 1998;171(6):1687\u20131692. doi:10.2214\/ajr.171.6.9843314"},{"issue":"5","key":"b3","series-title":"Pediatrics","first-page":"E69","article-title":"Coccygeal pits","volume":"105","author":"Weprin BE","year":"2000","unstructured":"Weprin BE, Oakes WJ. Coccygeal pits. Pediatrics. 2000;105(5):E69. doi:10.1542\/peds.105.5.e69"},{"issue":"2","key":"b4","series-title":"HK J Paediatr","first-page":"93","article-title":"Management of sacral dimples detected on routine newborn examination: a case series and review","volume":"12","author":"Lee ACW","year":"2007","unstructured":"Lee ACW, Kwong NS, Wong YC. Management of sacral dimples detected on routine newborn examination: a case series and review. HK J Paediatr. 2007;12(2):93\u201395."},{"issue":"3","key":"b5","series-title":"Pediatr Ann","first-page":"95","article-title":"The enigmatic sacro-coccygeal dimple: to ignore or explore?","volume":"43","author":"Block SL","year":"2014","unstructured":"Block SL. The enigmatic sacro-coccygeal dimple: to ignore or explore? Pediatr Ann. 2014;43(3):95\u2013100. doi:10.3928\/00904481-20140221-04"},{"issue":"3","key":"b6","series-title":"Pediatr Rev","first-page":"109","article-title":"Sacral dimples","volume":"32","author":"Zywicke HA","year":"2011","unstructured":"Zywicke HA, Rozzelle CJ. Sacral dimples. Pediatr Rev. 2011;32(3):109\u2013114,151. doi:10.1542\/pir.32-3-109"},{"issue":"2","key":"b7","series-title":"Pediatr Radiol","first-page":"211","article-title":"The simple sacral dimple: diagnostic yield of ultrasound in neonates","volume":"45","author":"Kucera JN","year":"2015","unstructured":"Kucera JN, Coley I, O\u2019Hara S, Kosnik EJ, Coley BD. The simple sacral dimple: diagnostic yield of ultrasound in neonates. Pediatr Radiol. 2015;45(2):211\u2013216. doi:10.1007\/s00247-014-3110-1"},{"issue":"8","key":"b8","series-title":"Acta Paediatr","first-page":"890","article-title":"Spine ultrasounds should not be routinely performed for patients with simple sacral dimples","volume":"105","author":"Albert GW","year":"2016","unstructured":"Albert GW. Spine ultrasounds should not be routinely performed for patients with simple sacral dimples. Acta Paediatr. 2016;105(8):890\u2013894. doi:10.1111\/apa.13422"},{"key":"b9","article-title":"Pediatric Neurosurgery - Five Tests and Treatments to Question. Choosing Wisely Canada","unstructured":"Pediatric Neurosurgery - Five Tests and Treatments to Question. Choosing Wisely Canada. Accessed November 18, 2025. https:\/\/choosingwiselycanada.org\/recommendation\/pediatric-neurosurgery\/?highlight=pediatric\u00b1neurosurgery"},{"issue":"6","key":"b10","series-title":"Paediatr Child Health","first-page":"383","article-title":"Choosing Wisely Canada: pediatric neurosurgery recommendations","volume":"23","author":"Radic JAE","year":"2018","unstructured":"Radic JAE, Cochrane DD. Choosing Wisely Canada: pediatric neurosurgery recommendations. Paediatr Child Health. 2018;23(6):383\u2013387. doi:10.1093\/pch\/pxy012"},{"issue":"1","key":"b11","series-title":"Australas J Ultrasound Med","first-page":"39","article-title":"Ultrasound examination of the neonatal spine","volume":"14","author":"Fitzgerald K","year":"2011","unstructured":"Fitzgerald K. Ultrasound examination of the neonatal spine. Australas J Ultrasound Med. 2011;14(1):39\u201341. doi:10.1002\/j.2205-0140.2011.tb00186.x"},{"issue":"12","key":"b12","series-title":"Childs Nerv Syst","first-page":"1719","article-title":"International survey on the management of skin stigmata and suspected tethered cord","volume":"26","author":"Ponger P","year":"2010","unstructured":"Ponger P, Ben-Sira L, Beni-Adani L, Steinbok P, Constantini S. International survey on the management of skin stigmata and suspected tethered cord. Childs Nerv Syst. 2010;26(12):1719\u20131725. doi:10.1007\/s00381-010-1184-0"},{"issue":"3","key":"b13","series-title":"J Neurosurg Pediatr","first-page":"274","article-title":"Use of lumbar ultrasonography to detect occult spinal dysraphism","volume":"9","author":"Chern JJ","year":"2012","unstructured":"Chern JJ, Kirkman JL, Shannon CN,  Use of lumbar ultrasonography to detect occult spinal dysraphism. J Neurosurg Pediatr. 2012;9(3):274\u2013279. doi:10.3171\/2011.12.PEDS11351"},{"issue":"2","key":"b14","series-title":"Childs Nerv Syst","first-page":"285","article-title":"Occult spinal dysraphisms in newborns with skin markers: role of ultrasonography and magnetic resonance imaging","volume":"34","author":"Ausili E","year":"2018","unstructured":"Ausili E, Maresca G, Massimi L, Morgante L, Romagnoli C, Rendeli C. Occult spinal dysraphisms in newborns with skin markers: role of ultrasonography and magnetic resonance imaging. Childs Nerv Syst. 2018;34(2):285\u2013291. doi:10.1007\/s00381-017-3638-0"},{"issue":"7","key":"b15","series-title":"JAMA Netw Open","first-page":"e207221","article-title":"Incidence of occult spinal dysraphism among infants with cutaneous stigmata and proportion managed with neurosurgery: a systematic review and meta-analysis","volume":"3","author":"Choi SJ","year":"2020","unstructured":"Choi SJ, Yoon HM, Hwang JS,  Incidence of occult spinal dysraphism among infants with cutaneous stigmata and proportion managed with neurosurgery: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(7):e207221. doi:10.1001\/jamanetworkopen.2020.7221"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/37\/5\/article-p402.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/37\/5\/article-p402.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/37\/5\/article-p402.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T14:19:05Z","timestamp":1781187545000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/37\/5\/article-p402.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,13]]},"references-count":30,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2025.10.peds25213","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,13]]}}}