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This was a one day old infant who, uh,

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underwent screening spine ultrasound

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for multiple congenital anomalies.

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This patient had esophageal atresia

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and so there was concern for ral malformation,

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so vertebral body anomalies, anorectal malformation,

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cardiac anomalies.

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The T is tra esophageal fistula,

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which this patient had the esophageal

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atresia version of that.

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Um, and then limb abnormalities is the l.

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So we are presented

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with this spine ultrasound in this one day old infant.

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So we are imaging with our linear high frequency transducer.

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This infant is in the prone position

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and we are starting in the longitudinal or sagittal plane,

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and we can see vertebral bodies

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and intervertebral disc spaces anteriorly.

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We see posterior elements at the, uh,

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at the superficial aspect of the screen

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because we are imaging from a posterior approach.

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And then here is our spinal cord

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and our spinal canal contents

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with a nice normal looking cord.

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Nice, normal, uh, looking central app penal canal

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and nice normal looking anaco CSF at the dorsal

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and ventral aspects of this cord.

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As we go inferiorly though, we're going to, uh,

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pay close attention to the morphology of our conus meis.

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We're gonna look at where are thecal sac ends,

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and we're gonna look at our phylum terminality.

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So when we're trying to guess,

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or trying to label appropriately the levels

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of the vertebral bodies,

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we're gonna in our mind's eye draw a line parallel

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to the lumbar spine vertebral bodies.

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We're gonna draw a line parallel

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to the sacral vertebral bodies

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and where they intersect is going to be L five S one.

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So this is L five. This is S one

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as a confirmatory thing we can do in this patient is the

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thecal sac should end at the S two vertebral body.

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So this is, uh, confirming

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that this vertebral body is S two.

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So S two sacral two, sacral one L five vertebral body,

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L four vertebral body n conus meis.

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It extends all the way to the L four vertebral body.

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Not only that, this is our phylum terminality

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and this looks just a little bit thick to me.

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Um, I don't see it measured, um, by our stenographer,

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but this is gonna be an abnormal, uh, lumbar spine, uh,

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abnormal position of the conus mellis

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concerning for tethered cord.

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So this patient will go on to MRI.

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So the t here is showing us

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that the coil segments are un ossified.

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We have normal, rectangular

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or square shapes of our sacral vertebral bodies.

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This is L five and again, our conus meis,

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we can see at the superior aspect

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of the screen here extends all the way to L four.

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So this is a low line conus meis.

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Um, we don't see evidence of a presacral mass, so don't,

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just don't forget to look at your vertebral bodies,

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look at the spinal cord contents, look at your, uh,

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coil segments, but also look at the rectum

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and see if there's any sort

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of abnormal heterogeneous mass in this infant.

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Especially in an infant with multiple congenital anomalies.

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You don't wanna miss a presacral mass, um,

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coexisting at the same time.

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Our tech has labeled the levels for us.

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Thank you stenographer. So this uh, spin is process.

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They have labeled as L three.

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So this is the L three vertebral body. This is L four.

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So they're counting matches our counting

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with this conus mellis extending all the way

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to the L four vertebral body.

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We're gonna look at our motion next.

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So on this cinematic image, uh, normally the nerve rootlets

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of the coquina

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and the conus midis move nice with, uh, respiratory motion

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with cardiac pulsations.

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And this just looks stuck.

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There's not a ton of movement of these nerve rootlets

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of the coquina surrounding this lowly conus meis.

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Um, this phylum terminology on the syn image doesn't look

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particularly thick, but it's not moving.

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So this is concerning for, um, lowly conus meis.

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So concerning for tethered cord, this patient will go on

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to lumbar spine, uh, screening

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or, uh, this patient will go on to follow up spine MRI

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to confirm findings and for preoperative planning.