| Sacral dimple: clinical perspectives of lesions hidden
beneath the skin |
Jin Eun1 
, Kwan Sung Lee2
, Seung Ho Yang3
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1Department of Neurosurgery, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
2Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
3Department of Neurosurgery, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea |
Correspondence:
Seung Ho Yang, Email: 72ysh@catholic.ac.kr
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Received: 8 August 2025 • Revised: 25 September 2025 • Accepted: 1 October 2025 |
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| Abstract |
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Sacral dimples are the most common cutaneous anomalies
in
newborns. While usually benign anatomical variants, some
dimples are indicative of occult spinal dysraphism, such as a
tethered cord, dermal sinus tract, or lipomyelomeningocele,
that, if undiagnosed, may cause irreversible neurological,
orthopedic, and urological deficits. Distinguishing benign
from high-risk dimples is essential for timely intervention.
This review summarizes the embryological origins, diagnostic
criteria, imaging approaches, and management strategies
for sacral dimples
to help clinicians identify cases
requiring further evaluation. A comprehensive literature
review examines the embryology of caudal spinal development,
classification of spinal dysraphism, and studies of
the diagnostic accuracy of ultrasonography and magnetic
resonance imaging (MRI) in infants with sacral dimples.
Guidelines and high-quality studies of the surgical outcomes
of tethered cords and related
anomalies were also analyzed.
The literature search and study selection followed the Preferred
Reporting Items for Systematic Reviews and Meta-
Analyses flow. Simple sacral dimples—solitary midline depressions
less than 5 mm in diameter, located within 2.5 cm
of the anus, and lacking associated cutaneous stigmata—
are not associated with spinal dysraphism and do not
require imaging. In contrast, atypical dimples (large, deep,
off-midline, or associated with skin markers such as hair
tufts or hemangiomas) are significantly associated with
occult anomalies and warrant
imaging, beginning with
spinal ultrasonography in neonates and MRI in older infants
or equivocal cases. Conditions such as tethered cord,
dermal sinus tract, lipomyelomeningocele, and split cord
malformations are best visualized using MRI. Early surgical
detethering improves neurological, orthopedic, and bladder
outcomes, whereas delayed intervention risks permanent
deficits. Applying standardized criteria and targeted imaging
avoids unnecessary investigations while ensuring a
timely diagnosis of occult spinal dysraphism. Early recognition and appropriate surgical management, when indicated,
are critical for preventing neurological deterioration and
improving the prognosis of affected infants. |
| Key Words:
Sacrum, Spinal cord, Neural tube defects,Tethered cord syndrome |
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