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 under 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.