Spinal Congenital Dermal Sinuses: A 30-Year Experience

Abstract

Objective. Dermal sinus tracts are an uncommon form of spinal dysraphism often presenting in childhood with skin findings, neurologic deficit, or infection. We reviewed our surgical experience, examining presenting symptomatology, operative findings, and patient outcomes. Methods. A retrospective analysis of operated dermal sinus tract cases by the senior author (A.H.M.) from 1970 to present was made. Results. Twenty-eight patients were identified; 17 female and 11 male. Five cervical, 4 thoracic, 9 lumbar, and 9 lumbosacral tracts were explored. Sixteen patients presented at <1 year of age, and 12 were >1 year. Reasons for referral included cutaneous findings (15), neurologic deficit (8), foot abnormalities (4), infection (3), pain (2), and scoliosis (1). Our initial examination revealed cutaneous findings (eg, sinus ostea, pigmentation changes, erythema, skin tags, subcutaneous masses) in 27 patients and neurologic deficit in 19. Age-related differences were apparent. Patients >1 year were more likely to have neurologic deficit (92%) as compared with those <1 year (50%). Bifid spinous processes were noted at dural tract entry in 17 patients. Twenty-two tethered cords, 14 inclusion tumors, and 6 patients with evidence of arachnoiditis were found intraoperatively. Mean follow-up was 33 months. Eleven (39%) remained neurologically intact, 12 (43%) improved, 2 (7%) were unchanged, and 3 (11%) were worse with 2 having decreased perianal sensation and 1 slightly worsened motor function postoperatively. Conclusions. Although most patients were referred for cutaneous stigmata evaluation, >50% had neurologic deficit, intradural tumors, or tethered cords. Skin findings identification should initiate prompt radiologic evaluation and neurosurgical intervention with intradural exploration. Timely intervention may preserve or improve neurologic function in these patients.