Each of these aesthetic units impacts the overall gluteal aesthetic and should be addressed when planning gluteal. there is a duplicated gluteal cleft there is more than one dimple the dimple lies outside the sacrococcygeal region there are any neurological abnormalities noted The above may be. Although fistulas above the gluteal cleft may be associated with spinal dysraphism, coccygeal pits are benign and do not need imaging. As a result, no further investigation is needed for these simple dimples. Sacral Dimples and Pits: Background. Sacroiliitis can cause pain and stiffness in the buttocks or lower back, and the pain might go down one or both legs. Simple sacral dimples require no further investigation whereas complex ones do. If the base could not be seen, this would be called a coccygeal pit. A simple sacral dimple, defined as a midline dimple, within the gluteal cleft and without associated cutaneous abnormalities, is a common finding and considered to be a. 8. sacral dimple. The sacral cornu, which flanks the rostral margin of the sacral hiatus on either side, acts as the surface. Indications for imaging included isolated dimple in 235 patients (45%), asymmetrically deviated gluteal cleft in 43 (8%), symmetrically deviated (Y-shaped) gluteal cleft in 38 (7%), hemangioma in. This can then lead to the subsequent formation of a subcutaneous abscess from a persistent folliculitis. 6 became effective on October 1, 2023. Careful inspection of the natal cleft for dimples and symmetry may reveal a dimple below the top of the gluteal crease in 2% to 4% of normal newborns. Sacral dimple newborn – a prototypical benign sacral dimple that is located within the gluteal cleft (less than 2. 91 is grouped within Diagnostic Related Group(s) (MS-DRG v 41. My oldest has a “duplicated gluteal cleft” which is also a marker for spina bifida. A simple sacral dimple, defined as a midline dimple, within the gluteal cleft and without associated cutaneous abnormalities, is a common finding and considered to be a. The only significant finding in that area would be a sacral dimple that is deep and that might need investigating for a condition known as spina bifida occulta. There is no skin. It is shaped like an upside-down triangle and sits at the bottom of the spinal column, connecting it to the pelvis. The tests listed below will help you indicate an innocent sacral dimple: Markers of Spinal Dysraphism UCSF Pediatric Brain Center(a) Transient dilation of the central canal in a 2-week-old male with a sacral dimple. Sometimes called the Cleft procedure, this surgery removes all the skin covering the involved area. 8 may differ. Spina Bifida Occulta (Occult Spinal Dysraphism) Spina bifida occulta is a common anomaly consisting of a midline defect of the vertebral bodies without protrusion of the spinal cord or meninges. Open neural tube defects are lesions in which brain, spinal cord, or spinal. Results: The most common lumbosacral cutaneous manifestations were bifurcated/duplicated gluteal folds (33%), gluteal asymmetry (19%), and sacral dimples (14%). A full thickness skin flap is mobilized across the gluteal cleft to create an off-midline closure (Fig. Dimples can also occur higher up above the gluteal cleft. basically, the top of his bum crack makes a y shape…Case description: We present a case of a 6-month-old male with a low-lying conus medullaris, lumbar syrinx, mildly abnormal urodynamic studies, and asymmetric utilization of his lower extremities observed during the evaluation of a Y-shaped gluteal cleft. Code Tree. This can cause problems starting around age 2-3 (potty training age) is when parents start to see some signs. 01 coding with all applicable Excludes 1 and Excludes 2 notes from the section level conveniently shown with each code. On the other hand, "sacral dimples" are higher on the lower back, usually on both sides (not in the middle). Semantic Scholar extracted view of "Sacral dimples. Data were analyzed on 151 newborns; average age at the time of USG was 1. Most of the abnormal findings in patients with sacral dimples were of no clinical significance. In this design, the advancement is done in a V-Y fashion and the medial portion of the flaps are elevated and advanced to cover the sacral defect. Spinal dysraphism is a group of diverse conditions that have variable imaging patterns. Cute vs. It's usually located just above the crease between the buttocks. These anomalies occur in 4% of newborns 1 with fewer than half prompting medical concern. 5 cm from the anus; midline without visible drainage; not associated with other cutaneous. Each hip bone consists of three fused bones: the ilium, ischium, and pubis. Specialty: General Surgery. Sacral dimple ultrasound – sagittal ultrasound showing normal conus level and no underlying spinal dysraphism (red circle is approximate area of cutaneous sacral dimple) The vertical line starts from sacrum to the perineum. Of our soft-tissue appendages, two were surrounded by patches of hypertrichosis. An approach to ultrasound investigation of sacral dimples is presented in . The 2022 edition of ICD-10-CM Q82. Stumbling or changes in gait or walking. z. 5 cm in diameter, and are not associated with any other cutaneous abnormalities (Figs. Intermediate Risk Category • Imaging is required in the following circumstances (ultrasound if age <6 months or MRI if age ≥6 months):6, 14,25 An atypical dimple is larger than 5 mm and located within 25 mm of the anus. The upper angle is determined by the crossing of the bilateral. Urinary and bowel dysfunction are nearly universal. Pilonidal cysts and sinuses are a spectrum of pilonidal disease conditions that occur between the buttocks (gluteal crease or cleft) near the tailbone in the lower back. The two major types of spinal dysraphism are based on the appearance, i. The only significant finding in that area would be a sacral dimple that is deep and that might need investigating for a condition known as spina bifida occulta. At her check up her doctor noticed that she has a y shaped gluteal crease. reported a sacral dimple above a prominent, retroverted coccyx . Three had associated asymmetric or Y-shaped gluteal clefts. Sacral epidermal anomalies include dimples, tracts, lipomas, hemangiomas, and tufts of hair and may be associated with a neural tube defect, such as spina bifida. Since my little one was born, I find that the sacral dimple to the separation line of her left and right buttocks does not look in symmetry, sth like a "C" shaped. The sacrum is a single bone comprised of five separate vertebrae. not associated with other cutaneous stigmata of spinal dysraphism (e. (B) Sever all knee ligaments. Indications for lumbar spine sonography include multiple congenital anomalies placing an infant at increased risk, complicated sacral dimple (location above the gluteal crease, bottom of pit not seen, possible drainage from dimple, and presence of skin stigmata), softtissue mass suspected of being spina bifida occulta, determination of reason. 3 March 2011 111 The intergluteal cleft or just gluteal cleft, also known by a number of synonyms, including natal cleft, butt crack, and cluneal cleft, is the groove between the buttocks that runs from just below the sacrum to the perineum, [1] so named because it forms the visible border between the external rounded protrusions of the gluteus maximus muscles. From icd10data. 5 cm from the anus) 2. In patients with a sacral dimple, the location of the dim - J neurosurg Pediatr). An approach to ultrasound investigation of sacral dimples is presented in . Dimple is oriented straight down (i. g. org. Most sacral dimples are harmless. I have read a post on here where a mama's baby did have a y shaped crack, sacral dimple and a tethered cord and the baby will have surgery at 6 months. A sacral dimple. There was no difference in the rate of OSD based on dimple location. Pregnancy was. 5 cm of the anus), and do not have an associated cutaneous abnormality [4,5,6]. 5 × 1-cm lumbosacral skin appendage (black arrow), slightly to the left of midline, plus a y-shaped gluteal cleft. These guidelines have therefore been prepared with a view to ensuringMy son who is 6 months old is scheduled for a MRI in June to check for a tethered cord. Summary. Position – within the gluteal fold or coccygeal position. Monday she will see a neuro sergion for a physical exam. sacral dimple, asymmetrical gluteal cleft, and presence of other congenital anomalies like multiple segmentation and fusion vertebral anomalies. Topics: congenital abnormality , cysts , magnetic resonance imaging , salmon patch , skin manifestations . Indications for imaging included isolated dimple in 235 patients (45%), asymmetrically deviated gluteal cleft in 43 (8%), symmetrically deviated (Y-shaped) gluteal cleft in 38 (7%), hemangioma in. The sigmoidplasty closure was performed. Longitudinal grayscale. By Perrine Juillion / October 25, 2019. 21 The dimple has an underlying tract of epithelial and fibrous tissue that pierces the underlying fascia and posterior vertebral elements, pierces the dura, and tracks. Otherwise, in the case of atypical sacral dimple, deviated gluteal cleft, or association of two specific cutaneous markers, we suggest to perform US. Boston Children’s Hospital. 89. There is a necessity for detailed embryological knowledge for a better. A sacral dimple is diagnosed with a physical exam, usually during a baby's first exam. The patient is placed in prone position with a bolster under the abdomen to facilitate the opening of the sacral hernia. It is present by birth in babies. At 6 months all her lanugo fell off except this little patch of hair on her low back and it looks like a little grey spot above the gluteal deviation. hemangioma at site of dimple and spreading to anus. buttocks The intergluteal cleft or just gluteal cleft, also known by a number of synonyms, including natal cleft, butt crack, and cluneal cleft, is the groove between the buttocks that runs from just below the sacrum to the perineum, so named because it forms the visible border between the external rounded protrusions of the. A total of 34 (24%) patients had an abnormal spinal ultrasound; 15 (44%) of these infants underwent a lumbar magnetic resonance imaging. I have read a post on here where a mama's baby did have a y shaped crack, sacral dimple and a tethered cord and the baby will have surgery at 6 months. A total of 34 (24%) patients had an abnormal spinal ultrasound; 15 (44%) of these infants underwent a lumbar magnetic resonance imaging. Each referred participant was risk stratified based on specific physical exam findings. 5 cm from the anus. Changes in the way the feet look, like higher arches or curled toes. Evaluation for potential OSD usually. Most coccygeal dimples are located near the midline, within or just above the gluteal crease (within 2. Apr 24, 2016 at 7:40 PM. Sacral pits with cutaneous markers (lipoma, hypertrichosis, hemangioma)In fact, the authors feel that simple dimples and deviated gluteal clefts do not require any imaging whatsoever [13]. I almost thought they just made that up!Download MyChart to connect with your care team. Figure 14. Deep dimples. (b) Normal comparison in a 31-day-old male with a sacral dimple. In this condition, the patient do not have a sacral dimple on both or either side. 5 cm, and falls within the superior portion or just above the gluteal cleft, and/or is associated with other cutaneous markers for neural tube defects, the infant is more likely to have an underlying neural tube defect. Sacral dimple newborn – a prototypical benign sacral dimple that is located within the gluteal cleft (less than 2. Pilonidal sinuses are characterized by natal cleft suppuration and are thought to initially result from a hair follicle infection. Albert G (2016) Spine ultrasounds should not be routinely performed for patients with simple sacral dimples, Acta Paediatrica, 10. 1 ): Medially: intergluteal crease, sacrum, and coccyx (sacral triangle, also known as V-shaped crease) Superiorly: posterior-superior iliac spine (PSIS), iliac crest. Indications for imaging included isolated dimple in 235 patients (45%), asymmetrically deviated gluteal cleft in 43 (8%), symmetrically deviated (Y-shaped) gluteal cleft in 38 (7%), hemangioma in. g. Q82. Dysraphism results when the neural plate does not fuse completely in its lower section. Her skin was warm, dry, and pink, with a 3. Open the PDF for in another window. 5 cm above the anus) and solitary. A comprehensive review of 200 patients with spinal dysraphism found that 102 had a cutaneous sign. Normal neurological examination. Children with sacral agenesis have characteristically flattened buttocks with a shallow gluteal cleft, a palpably absent coccyx, and distal leg wasting described as. The sacral dimple formed early in an Embryological state. nervous system sacral dimples Pediatrics in Review Vol. FACSsshureih@msn. Hair can then enter the abscess cavity and provoke a foreign body tissue reaction. • The presence of more than one skin dimple anywhere along the neural axis is an indicator of the likely presence of OSD. They do not. Lagertha1. We classified dimples at the initial consultation, not at the time of MRI. We have been told our 6 week old son has a forked gluteal (naval) cleft or I y-shaped crease at the top of his button - Answered by a verified Pediatrician. From a posterior-anterior view, the gluteal region may be divided into two symmetric “flank” units, “sacral triangle” unit, two symmetrical gluteal units, two symmetric thigh units, and one “infragluteal diamond” unit. A simple sacral dimple, defined as a midline dimple, within the gluteal cleft and without associated cutaneous abnormalities, is a common finding and considered to be a. Longitudinal grayscale ultrasound image demonstrates mild dilation (arrow) of the most caudal aspect of the central canal, immediately cranial to the conus medullaris. 5-cm diameter erythematous indurated raised area with fluctuance superior to the gluteal cleft at the base of the lumbar spine (Figure 1). 신생아 보조개 (Sacral Dimple) 은. 5 cm, and falls within the superior portion or just above the gluteal cleft, and/or is associated with other cutaneous markers for neural tube defects, the infant is more likely to have an underlying neural tube defect. Asymmetric or malformed Gluteal cleft. These mimics could be Benign sacral dimple or pilonidal sinus. Skin stigmata were classified into seven types, dimple, deformed gluteal cleft, hair, subcutaneous mass, appendage, discoloration, and protruding bone, and included 1056 isolated and 199 complex ones. Rozzelle. Case 1. Showing 1-25: ICD-10-CM Diagnosis Code Q82. Fossae lumbales laterales (dimples of Venus), which are considered to be hereditary, manifest themselves as symmetrical indentations on the lower back, above the gluteal cleft. Subcutaneous lipomas. Background. < 5 mm diameter. Has anyone had any expierence with this ? Thanks x. Rozzelle. 5 cm above the anus) and solitary. The hip joint is the most stable joint in the body and is supported by a very strong capsule and several. May be associated with VATER association, imperforate anus, cloacal extrophy and other urogenital abnormalities. We would like to show you a description here but the site won’t allow us. Jun 18, 2023 at 1:42 PM. Sometimes a/w sacral agenesis Reflects defective. Sacral dimples with higher risk characteristics should undergo ultrasound. The finding of sacral dimples in newborns has been considered as a cutaneous sign for underlying Occult Spinal Dysraphism (OSD). This area is the groove between the buttocks that extends from just below the sacrum to the perineum, above the anus and is formed by the borders of the large buttock muscles called the gluteus maximus. Although fistulas above the gluteal. Caudal regression syndrome results from an insult in early pregnancy (<4 th week of gestation). 8 became effective on October 1, 2023. These are referred to as duplicated or asymmetric or Y-shaped clefts or creases (Fig. 2. People can discuss. Any dimple lying superior to the gluteal cleft, outside the midline, and with a diameter greater than 5 mm commonly accompanies a spinal anomaly and warrants. 5 cm from anus. Asymmetric Y-shaped gluteal cleft that is moderately associated with spinal dysraphism except if present with other lesions. , saddle numbness and tingling, or weakness in arms or legs) Neurogenic BBD (spinal anomalies, transverse myelitis, central nervous system. ”Simple sacral dimples or pits (solitary dimple, < 5mm in diameter, situated in the. If it is readily visible on the back, above the upper gluteal limit, then the dimple is suspicious. Similarly, the authors found high agreement that simple coccygeal dimples do not need imaging. Sacral Dimples and Pits: Background. We should probably be reassured that it hasn’t been flagged with us! 1. 8, 13 Associated skin anomalies such as hair tufts or vascular lesions may also be found. O'Neill, Danielle Gallegos, Alex Herron, Claire Palmer, Nicholas V. (b) X-ray showed absent sacral elements. There was a right-ward displaced anal dimple and a patent anus. 01 [convert to ICD-9-CM] Pilonidal cyst with abscess. Deep dimples were noted in 1. Infants with a simple sacral dimple, with evidence of abnormal neurologic or orthopedic exam findings should be further evaluated F. A pilonidal sinus is a small hole or “tunnel” in the skin. 예전에는 잘 알려지지 않았지만. Corbett Wilkinson, Michael H. Now I’m freaking myself out because everything you see on google says tethered spinal cord. Among this group, 20% (46 of 235) had OSD. 8. 1111/apa. The depth of gluteal cleft varies and depend upon the developed gluteal muscles. A sacral dimple is found in the gluteal cleft and you will need to separate the glutes to find it. 5. 6 [convert to ICD-9-CM] Congenital sacral dimple. 6 - Congenital sacral dimple. 6 E. The intergluteal cleft is a surface anatomy landmark of the pelvis and lower limb. Dimple is less prominent. In association with other OSD associated. But if it's infected, the skin around the cyst may be swollen and painful. A. Sacral dimples or pits are common. A simple sacral dimple is defined as a solitary dimple less than 5 mm in diameter and less than 2. 91); Parasacral dimple. A sacral dimple is defined as a midline dimple less than 5 mm in diameter and no further than 2. Clinicians may identify similar conditions, but details will differ that aid in differential diagnosis. A prototypical benign sacral dimple that is located within the gluteal cleft (less than 2. The aim of this study was to determine the clinical. doi: 10. simple sacral dimple, defined as a midline dimple, within the gluteal cleft and without associated cutaneous abnormalities, is a common finding and. The lower part of the neural tube forms the spinal canal. The purpose of this study was to analyze unusual and complex dysraphism and propose a new classification based on clinicoradiological correlation and anatomical location. The crease is nearly always present and usually not perfectly symmetrical. There are several names for this area: natal cleft, gluteal crease, gluteal crevice. He underwent elective spinal cord detethering via the safe and effective, minimally. Each referred participant was risk stratified based on specific physical exam findings. A sacral dimple can be a sign of a serious spinal problem in a newborn if the dimple is large or appears near a. In female individuals, the pelvis additionally. Figure 1. His chromsome deletion also has tethered cord listed as a possible diagnosis. 8% to 7. TheHowever, if the sacral dimple is deep and large, greater than 0. My youngest has a sacral dimple but it is. Hankinson, C. These bones are firmly connected by the pubic symphysis anteriorly and the sacrococcygeal and sacroiliac joints posteriorly. Nine papers addressing routine spine ultrasounds for children with sacral dimples showed that 3. Sacral Dimple. If the base could not be seen, this would be called a coccygeal pit. typically beginning cephalad to the gluteal cleft and extending. Indications for imaging included isolated dimple in 235 patients (45%), asymmetrically deviated gluteal cleft in 43 (8%), symmetrically deviated (Y-shaped) gluteal cleft in 38 (7%),. Follow your baby's amazing development. 5% of 200. He did great & slept through the whole thing. 4). Perianal candidal intertrigo presents as soreness and irritation with bright red erythema and satellite lesions extending into the natal cleft. ANSWER: SACRAL DIMPLE The patient has an unusual sacral crease and sacral dimple. Although the literature suggests clinical consensus regarding some lumbosacral findings (simple dimples or slate gray macules),. e. Code. However, the vertebral defects may occur in association with other more severe anomalies of the spinal cord and sacral structures, such as split spinal cord malformation or various cavitary defects of the spinal cord. Cutaneous signs of spinal dysraphism (sacral dimple, deviated gluteal cleft, hair tuft) Neurogenic BBD (cord tethering, spina bifida/meningomyelocele, spinal tumors) Neurological deficits (i. A total of 34 (24%) patients had an abnormal spinal ultrasound; 15 (44%) of these infants underwent a lumbar magnetic resonance imaging. 5cm from the anal verge) Coccygeal pits (located within gluteal cleft, oriented caudally or straight down) Port Wine Stain or Telangiectases Intermediate Risk Category (Perform ultrasound if age <6 months or MRI if age ≥6 months)Code History. There are no differences reported among ethnic groups. 정상 변이로 양성인 경우가 대부분이지만. [Billable] [POA Exempt] There's more to see -- the rest of this topic is available only to subscribers. Indications for imaging included isolated dimple in 235 patients (45%), asymmetrically deviated gluteal cleft in 43 (8%), symmetrically deviated (Y-shaped) gluteal cleft in 38 (7%), hemangioma in. At times, it may be noted higher in the gluteal crease overlying the sacrum, but with skin. 2011 Mar;32 (3):109-13. 2% of newborn babies. Expand. This is the American ICD-10-CM version of Q82. 5 cm from anus · Less than 5 mm diameter · Localized in gluteal cleft Further workup needed No intervention needed Referral for MRI Further workup needed Age < 8 weeks? (more info) Yes Age < 8o weeks No Referring provider Age ≥ 8 weeks to order. abnormalities of 2nd toe on both feet. 7 th Character Notes; Category Notes; Chapter Guidelines; Get crucial instructions for accurate ICD-10-CM L05. g. 5 cm) 4. Perianal tinea is uncommon. Respondents would obtain imaging in 57%, 89%, and 65% respectively. 6 is a valid billable ICD-10 diagnosis code for Congenital sacral dimple . Type 3 dimples are located far above the gluteal crease and are sometimes associated with pigmentation, lipoma, and deviated gluteal crease. Download the BabyCentre app Opens a new window. A. including wattles, preauricular lesions, sacral sinuses, second branchial cleft anomalies, torticollis, and dermoid cysts. If it is, she would need surgery to have the the tethered cord snipped. Sometimes a Pilonidal contains hair and sometimes not. Current data shows that a screening ultrasound is appropriate. The deep fat deposits located in the flanks, sacral region, hips, and lateral and medial thighs must be identified as they will be treated with liposuction [8, 9]. A sacral dimple is a small dimple or cleft at the base of the spinal cord. All simple dimples were within the gluteal crease and had a visible, skin-covered base; all were <5 mm in size. Skin stigmata were classified into seven types, dimple, deformed gluteal cleft, hair, subcutaneous mass, appendage, discoloration, and protruding bone, and included 1056 isolated and 199 complex ones. Concerning findings warranting further work -up: dimples located superior to natal cleft or more than 2. Sacral dimples can be “typical” or “atypical”. Results. Babies with congenital hip dislocation can also have asymmetrical gluteal folds. It extends from sacral level S3 or S4 and ends just inferior to the apex of the sacrum, at the level of the anus. Gluteal Muscles. These dimples are located at or near the tip of the coccyx within the gluteal cleft and are visible only when the buttocks is parted (Figure 1A). She took some pictures and sent them to a neurosurgeon who said we. pressure on the ankles, heels and buttocks as too much pressure can tear the thin. 01); pilonidal cyst without abscess (L05. Sacral Dimples Holly A. They did an ultrasound of his booty & spine when he was like a week old. If the sacral dimple is large or appears with a nearby tuft of hair, skin tag or lump, or certain types of skin discoloration, your health care provider may suggest imaging tests to check for spinal cord problems. 5%. Arch Dis Child. not associated with other cutaneous stigmata of spinal dysraphism (e. a. A Guide to Pediatric Anesthesia. They represent a heterogeneous group ranging from mild clinical manifestations—going unnoticed or being discovered at clinical examination—to a causal. These bilateral lines create a desirable sacral diamond on the patient’s lower back, which mimics the rhomboid area of Michaelis. e. com. Epigastric mass; Epigastric swelling, mass. [Zywicke, 2011] Neural Tube Defects: [Zywicke, 2011] Open vs Closed When an infant is born with skin lesions or abnormalities of the lower back or gluteal cleft, the possibility of an association with spinal malformations, such as tethered cord syndrome, often prompts pediatricians to recommend spinal imaging. Zywicke et al. If it is readily visible on the back, above the upper gluteal limit, then the dimple is suspicious. Figure 4. Tabs. It goes laterally up to a virtual line converging the anterior superior iliac spine to the anterior edge of higher trochanter and Medially goes up to mid-dorsal line and natal cleft. Remove the tibia and fibula. Back dimples, including sacral and venus dimples, are indentations in the lower area of the back. 6 became effective on October 1, 2021. , hemangiomas. The upper part of the neural tube forms the forebrain, midbrain and hindbrain. It is found in the small of the back, near the tailbone, which is also known as the sacrum. The gluteal fat is allowed to appose and excess skin is excised to re-contour the natal cleft and allow a shallower closure away from the midline. 4 ). IU22 L12-5. This can then lead to the subsequent formation of a subcutaneous. An approach to ultrasound investigation of sacral dimples is presented in . 1. 2). Posted 06-24-17. The nurse recognizes this as a sacral. Multiple dimples were encountered. 5 cm, are positioned below the gluteal folds and have no other cutaneous features (dark hair, colour change) are innocent and do not require any further investigation. There is a necessity for detailed embryological knowledge for a better understanding of. Duplicated gluteal crease. 5%) of tethered cord, including 21 with thickened and fatty Fig. Motor function is generally more affected than sensory function and is correlated with the level of spinal aplasia. Hyperglycemia, infection, toxic and ischemic insults have been implicated. Pilonidal sinuses are characterized by natal cleft suppuration and are thought to initially result from a hair follicle infection. Skin stigmata were classified into seven types, dimple, deformed gluteal cleft, hair, subcutaneous mass, appendage, discoloration, and protruding bone, and included 1056 isolated and 199 complex ones. Doctors usually use ultrasound to find out if the dimple is. The thing is I also did notice during diaper changes there was a dimple there. Sacral dimples show up in 1. The shape from dimple to gluteal crease resembles an inverted exclamation mark (Fig. 1 Atypical Sacral Dimple: Not in midline, not in sacrococcygeal region, >5 mm deep, >2. 49. gluteal cleft / natal cleft / cluneal cleft / butt crack) is the posterior deep midline groove in the gluteal region. Gluteal Region is the back and side of lateral half of pelvic region. tenderness. Scientists don’t know for sure what causes sacral dimples, but it may be genetic. The fissure in the underlying bone is from the imperfect fusion of two halves of the jaw bone. Most patients are asymptomatic and lack neurologic signs, and the condition is usually of no consequence. Single dimple. The sacrum consists of five fused sacral vertebral and costal segments (numbered one-to-five) that form a central sacral body and paired. 4 ). g. features of sacral agenesis: narrow hips, hypoplastic gluteal muscles, shallow intergluteal cleft; mild foot deformities and gait abnormalities; Pathology.