Minimal Spinal Dysraphism vs. Myelomeningocele
Left picture: The diagnosis is a minimal spinal dysraphism, probably combined with spine anomalies besides the often observed occult spina bifida. The capacity to stand and to walk is not impaired. Right picture: In this infant, we are not looking at a scar following a scald with healing by second intention, but a lumbosacrale myelomeningocele with spontaneous epithelization. The anomaly is combined with a high level of neurological deficit, e.g. with paraplegia of the legs and the pelvic floor. The local findings protruding over the skin level are explained by a moderate gibbus of the spine, the residuals of the divided vertebral arches, and by the advanced epithelizised medullary plate. Compare the picture at the top with the findings at birth in the figure at the bottom.
Left picture: A young toddler is held in a standing position with the back against the examiner. The spine is not in an up-right position; at the site of transition to the sacrum a conspicuous hairy zone is visible in the midline, and in the cranial direction from it up to the thoracic spine a large and less pigmented region with reddish streaks. Right picture: Although this male infant of the third trimenon is able to raise the head according to his age and prop up on his arms, but he is not capable of standing even when sustained by the examiner. His local lumbosacral findings include depigmented and reddish skin zones which protrude distinctly over the level of the surrounding normal skin.