Background: Pediatric spinal anomalies often necessitate
accurate and timely diagnosis for effective management.
This study aimed to assess the diagnostic value of spinal
ultrasound as initial modality for screening of pediatrics
spinal anomalies in comparison to MRI. Methods: This
cross-sectional study was conducted on pediatric patients
suspected of spinal cord disorders. A detailed clinical
examination, spinal ultrasound using high-frequency linear
array transducers, and MRI scans were performed on all
participants. Results: The 23.44 ± 32.02 days, 93.33% were
less than 60 days old. Females comprised 68.9%, males
22.2%, and 8.9% had ambiguous genitalia. Common
clinical presentations included back swelling (57.78%), hair
tuft (31.11%), and sacral dimple (24.44%). Most anomalies
involved the lumbosacral region (80%). Ultrasonography
exhibited high diagnostic validity, showing perfect
agreement with MRI for myelomeningocele, dorsal dermal
sinus, tethered cord, myelocele, disyomatomyelia with
segmental spinal dysgenesis, dermal sinus, myelocystocele,
and retethering of the cord (Kappa > 0.9). However, for
caudal regression syndrome, the Kappa value was 0.656,
indicating moderate agreement. The overall diagnostic
accuracy of ultrasound compared to MRI was above
95.56% across findings. Conclusion: Spinal ultrasound
demonstrates substantial diagnostic accuracy comparable to
MRI in identifying pediatric spinal anomalies, particularly
for various conditions such as myelomeningocele, dorsal dermal sinus, and tethered
cord.