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Prenatal Sonographic Diagnosis of Hemivertebra

Departments of Obstetrics and Gynecology (B.W., R.A., V.H.E., S.L., Y.Z.) and Pediatric Orthopedics (A.S.), Sheba Medical Center, Tel-Hashomer, Israel; affiliated with the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Address correspondence and reprint requests to Yaron Zalel, MD, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer 52621, Israel. E-mail: zalel_y{at}netvision.net.il.

Objective. To describe our experience in prenatal diagnosis of hemivertebra. Methods. This is a case series of patients referred to our tertiary medical center over a 3-year period. All fetuses were scanned by high-resolution real-time scanners. The apparent vertebral anomaly was assessed in a real-time manner by a joint team of obstetricians, sonographers, and pediatric orthopedic surgeons. A complete anomaly survey of other fetal organs was performed on each fetus. All patients were given proper counseling by the same joint team. All patients had detailed obstetric and neonatal follow-up. Prenatal sonograms, neonatal medical records, and clinical courses were evaluated retrospectively. Results. During the 3 years, 6 cases of hemivertebra were identified in our department. Gestational age at diagnosis was 14 to 23 weeks. Two patients had conception by assisted reproductive technology. Associated anomalies included VATER syndrome (vertebral defects, imperforate anus, tracheoesophageal fistula, and radial and renal dysplasia), gastroschisis, and pyelectasis. Outcomes in fetuses without major associated anomalies were fair. Conclusions. Diagnosis of isolated hemivertebra might be associated with a favorable outcome. The 3 key factors in achieving an optimal spine at maturity, early diagnosis, anticipation, and prevention of deterioration, might be enhanced by our joint multidisciplinary approach to the diagnosis of skeletal anomalies.

Key Words: congenital scoliosis • hemivertebrae • prenatal diagnosis • sonography

Abbreviations: VACTERL, vertebral, anal, cardiac, tracheal, esophageal, renal, and limb • VATER, vertebral defects, imperforate anus, tracheoesophageal fistula, and radial and renal dysplasia

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