Spinal ultrasound is the modality of choice for screening of neonatal spinal anomalies. Ultrasound is cost effective and available. It is performed with high –frequency linear transducer in axial and sagittal plane from cervical to sacro-coccygeal. No sedation is need and it done in prone position with a rolled towel under the abdomen and warm gel. Ultrasound uses for evaluation of neonates with signs of spinal anomalies as sacro-coccygeal dimple, cutaneous lesion, scoliosis, anal atresia and detection of congenital spinal anomalies as spina bifida, tethered cord, diastematomyelia, caudal regression syndrome, intradural lipoma and acquired disease as post injury, post-surgery, post LP complications, infection and abscess. We should know anatomical variants as filar cyst (ventricularis terminalis) and transient dilatation of the central canal. With spinal ultrasound, conus medullaris level, movements of Cauda-equina with heart pulsation and breathing and position of neural roots of Cauda-equina in thecal sac can be determined. For open neural tube defects and csf leak scanning sterile technique is required and MRI is the modality of choice.