Sacral dimples

Ever seen a tuft of hair over the lower back or a sacral dimple? Learn how to recognize and manage normal vs abnormal back and spinal findings in our episode today. 

Follow us on Twitter/X @Pediagogypod and Instagram/Threads @pediagogy and connect with us at [email protected]. 

This episode was written by Dr. Tammy Yau and Dr. Lidia Park, with content support from Dr. Laura Kair. Drs. Tammy and Lidia take full responsibility for any errors or misinformation. 

Key points: 

• Spinal dysraphism is the incomplete fusion of the spine during development. 
• Not all spinal dysphraphisms will have abnormal cutaneous manifestations that you can see on exam 
• Diagnose spinal dysphraphisms with spinal ultrasound in young children and MRI in older children 
• Sacral dimples can be normal but should be worked up if they are larger than 5 mm at the base, above 2.5cm from the anus, not midline, or if there are multiple dimples 

Sources 

• Pediatrics in Review 2019, Holmes and Li: https://doi.org/10.1542/pir.2018-0155  
• Peds in Review 2011, Zywicke and Rozzelle: https://doi.org/10.1542/pir.32-3-109  
• Hospital Pediatrics 2020, Aby et al: https://doi.org/10.1542/hpeds.2019-0264