Within Enable Law, we have seen a marked increase in enquiries relating to sacral dimples and other abnormalities such as birthmarks or tufts of hair on the spine and associated delays in diagnosing underlying spinal conditions. It is important to recognise the warning signs of abnormal sacral dimples and what to expect when further investigation and intervention is required.
What are sacral dimples?
Sacral dimples are small indentations typically located at the base of the spine or within the crease of the buttocks. They are present in approximately 2 – 8% of new borns and the majority are benign. However, in those minority cases where abnormalities are present, sacral dimples can be an early indicator for underlying spinal defects which can have a lasting impact upon a child.
How are sacral dimples diagnosed?
Almost immediately after a baby is born, a physical examination is performed by a midwife or paediatrician to exclude any physical abnormalities, including looking at the lower spine to check for any congenital dimples.
How the sacral dimple appears determines whether there is need for further examination.
A normal sacral dimple will generally be under 5mm in size, shallow, less than 25mm from the anus, and midline (central). Sacral dimples such as these are not immediately associated with underlying spinal conditions and a doctor may reasonably advise not to proceed with any further investigation unless there are other abnormalities also present.
What are the atypical features of a sacral dimple?
Atypical features of a sacral dimple include: –
- Over 5mm in size.
- Deep, unable to see the base.
- Situated over 25mm from anus.
- Not midline/centralised.
- Have a tuft of hair.
- Skin lesion/discolouration.
- Skin tag/lump.
- Accompanied by other dimples.
These markers are generally considered indicators of a potential spinal condition.
If a doctor suspects an underlying issue, what should happen?
If any abnormal features of a sacral dimple are identified, a doctor should arrange for the baby to undergo further investigation with a specialist. These investigations are usually an ultrasound scan, and this may be followed by an MRI scan if the ultrasound suggests any spinal abnormality such as:
- Spina bifida
- Tethered cord syndrome
- A dermal sinus tract connecting the dimple to the spine
What are the risks of abnormal sacral dimples?
Underlying spinal conditions such as tethered cord syndrome or spina bifida can cause a wide range of symptoms including: –
- Lower back pain.
- Spinal curvature.
- Weakness in lower limbs.
- Restricted mobility.
- Bowel and bladder incontinence.
If the sacral dimple is connected to the spinal canal, this creates an open channel known as a dermal sinus tract. This can provide a pathway for bacteria to pass from the skin to deeper tissues and the spine which creates an infection risk, including for meningitis.
Early intervention is critical. Where there is a delay in diagnosis of these conditions, a young child may not receive the appropriate neurosurgical intervention to prevent long term neurological issues.
How we can help
We often see missed opportunities to diagnose these conditions in clinical negligence. It is crucial to recognise the abnormal features of sacral dimples so that these can be investigated.
At Enable Law, we have decades of experience supporting people who have suffered injury because of the actions or negligence of medical professionals. If you have concerns about the care you or one of your loved ones have received, we are here to help. All initial conversations are free with no obligation and aim to help you understand what may have happened. To have a free, confidential discussion with a member of our dedicated team call us today on 0800 044 8488 or fill in our contact form so we can get in touch with you at a time convenient for you.
If you or anyone you know suspects that a sacral dimple has been missed or not investigated appropriately, please contact our specialists, Laura Wallace or Claire Leslie, who would be happy to discuss any concerns.
We also work closely with the charity, Shine. This specialises in providing advice to families with children who have spina bifida as well as hands on support through a number of dedicated service teams. To find out more about the charity and the great work they do visit Shine – Spina Bifida & Hydrocephalus.
