Sonography is one of the first-line methods of imaging used in evaluating the neonatal spine, being well established for infants. Sonography is a well-established and first-line method of imaging the neonatal spine for infants less than 3 months of age. It is effective in evaluating the spinal cord, cauda equina and nerve roots, spinal canal, filum terminale, and to assess for defects in the posterior elements with or without superficial abnormalities, though osseous evaluation is suboptimal sonographically and best paired with other modalities. The most common indication for imaging is as a screening exam for cord tethering in the setting of a cutaneous lesion or dimple at the lower back. One should be aware of the normal sonographic appearance and normal variants, as well sonographic appearance of pathologies such as types of spinal dysraphism and caudal regression syndrome, sinus tracts, intradural and filar lipomas, and teratomas and other masses, among other possible findings.