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Hemivertebra

Half Vertebra


Presentation

  • Little has been written about congenital scoliosis presenting in adulthood. Because the aging of the spine is a kyphosing process and hemivertebrae often present with a local segmental kyphotic alignment, this can become symptomatic.[ncbi.nlm.nih.gov]
  • Seventy-six of these patients had had magnetic resonance imaging and were included in the present study. The mean age of these patients at the time of presentation was 4.9 years, and the mean duration of follow-up was 7.7 years.[ncbi.nlm.nih.gov]
  • Here the authors present the unique case of a man who, at the age of 12 years, had undergone Harrington rod placement for stabilization of progressive congenital scoliosis due to a T-11 hemivertebra and then, at the age of 53 years, presented with acutely[ncbi.nlm.nih.gov]
  • Both patients presented with back and leg pain, urinary hesitancy/incontinence, difficulty sitting and lying down, waddling gait, and restriction of movement.[ncbi.nlm.nih.gov]
  • A 71-year-old man presented with left lower back pain and intermittent claudication accompanied by severe left buttock pain.[ncbi.nlm.nih.gov]
Asymptomatic
  • Depending on their location and the magnitude of the resultant deformity, they may be asymptomatic or require treatment. In the past, treatment has focused on prevention of deformity progression in growing children.[ncbi.nlm.nih.gov]
  • Prenatal detection of this abnormality has become possible only within the past few years, so relatively little is known about the clinical significance of isolated asymptomatic vertebral defects.[mhmedical.com]
  • Last follow-up shows both patients were asymptomatic. In the 3rd patient, the fusion levels were T12-L5; the preop angle was 10o and increased to 26.54o at 24 months postop.[kundoc.com]
  • The cause for unilateral hyperplasia of lamina and spinous process is unknown but is usually asymptomatic and detected incidentally.[jocr.co.in]
Developmental Delay
  • We report on an 8-year-old girl with congenital scoliosis (segmented hemivertebra between the second and third lumbar vertebrae) and psychomotor developmental delay. She has a de novo reciprocal translocation, t(13;17)(q34;p11.2).[ncbi.nlm.nih.gov]
Infertility
  • A 35-year-old infertile man with unilateral renal and deferential agenesis, seminal vesicle cyst and hemivertebra is reported.[ncbi.nlm.nih.gov]
Soft Tissue Swelling
  • There was no associated soft tissue swelling or any other visible mass. Surgical intervention was requested by the parents of the patient in view of increasing size which was becoming a cosmetic issue.[jocr.co.in]
Delayed Wound Healing
  • Unanticipated surgeries were performed on eight patients, including one delayed wound healing, two pedicle fractures, one progressive deformity and four implants removals.[ncbi.nlm.nih.gov]
  • There was one case of delayed wound healing, two fractures of the pedicle at the instrumented level, two rod breakages and one proximal junction kyphosis that required revision. There were no neurological complications.[ncbi.nlm.nih.gov]
  • In 2011, Zhang et al. reported a 10.8 % complication rate in 56 cases during a mean follow-up of 32.9 months, including one delayed wound healing, two pedicle fractures, two rod breakages, and one additional surgery for proximal junction kyphosis [ 18[josr-online.biomedcentral.com]
Cutaneous Manifestation
  • Occult signs of spinal dysraphism include cutaneous manifestations such as midline spinal hemangiomas, penetrating sacral dimples, or midline hairy patches.[musculoskeletalkey.com]
Torticollis
  • We present our experience with two cases of C3 hemivertebra resection and torticollis correction via a combined anterior-posterior-anterior surgical approach and short segment fixation.[ncbi.nlm.nih.gov]
  • Keywords: Cervical scoliosis, hemivertebra, neck pain, torticollis Case Description A 15‐year‐old female patient, with known history of torticollis, presented with mild neck pain existing over the last 2 years.[ncbi.nlm.nih.gov]
  • Three patients with torticollis due to a cervical hemivertebra were operated on by hemivertebra resection and fusion of the adjacent vertebrae. Resection was performed by a posterior-anterior (-posterior) approach.[ncbi.nlm.nih.gov]
  • It locates between the mobile cervical spine and the fixed thoracic spine, leading to rapid curve progression, shoulder imbalance, fixed torticollis, and facial asymmetry.[ncbi.nlm.nih.gov]
  • A 14-year-old male presented with progressive torticollis and spine deformity. The malformation developed since birth, and back pain after long-time sitting or exercise arose since 6 months before, which was unsuccessfully treated by physiotherapy.[ncbi.nlm.nih.gov]
Buttock Pain
  • A 71-year-old man presented with left lower back pain and intermittent claudication accompanied by severe left buttock pain.[ncbi.nlm.nih.gov]
Leg Pain
  • Both patients presented with back and leg pain, urinary hesitancy/incontinence, difficulty sitting and lying down, waddling gait, and restriction of movement.[ncbi.nlm.nih.gov]
Muscle Spasm
  • The low oxygen levels could have been from the morphine IV and the injection she had during her surgery and the valium she had been given for muscle spasms. Those drugs can lower the respiratory system.[norasjourney-early-onset-congenital-scoliosis.com]
Suggestibility
  • Previous reports suggest that the diagnosis may be based on antenatal sonographic examination after 14 weeks.[ncbi.nlm.nih.gov]
  • Although this is only a single case, the good result with a long follow-up suggests the technique is worthwhile considering when planning the treatment of a lumbar hemivertebra in very young children.[ncbi.nlm.nih.gov]
  • These data suggest a difficulty in antenatal diagnosis of the condition. The majority of cases of hemivertebra had coexisting anomalies, and in these cases the rate of perinatal loss was high.[ncbi.nlm.nih.gov]
  • Posterior hemivertebra resection and monosegmental fusion was therefore suggested for treatment of congenital scoliosis caused by hemivertebra.[ncbi.nlm.nih.gov]
  • The current case suggests the importance of detailed preoperative examination of patients with anatomical abnormalities such as assimilated vertebrae, which may result in incorrect diagnosis and failed surgery.[ncbi.nlm.nih.gov]
Urinary Hesitancy
  • Both patients presented with back and leg pain, urinary hesitancy/incontinence, difficulty sitting and lying down, waddling gait, and restriction of movement.[ncbi.nlm.nih.gov]
Waddling Gait
  • Both patients presented with back and leg pain, urinary hesitancy/incontinence, difficulty sitting and lying down, waddling gait, and restriction of movement.[ncbi.nlm.nih.gov]
Radiculopathy
  • Far-out syndrome was reported by Wiltse et al. in 1984, which is a condition characterized by L5 spinal nerve radiculopathy due to nerve compression between the L5 transverse process and sacral alar.[ncbi.nlm.nih.gov]

Treatment

  • Depending on their location and the magnitude of the resultant deformity, they may be asymptomatic or require treatment. In the past, treatment has focused on prevention of deformity progression in growing children.[ncbi.nlm.nih.gov]
  • To our knowledge a fusionless surgical solution for the treatment of a hemivertebra has never been described before.[ncbi.nlm.nih.gov]
  • No treatment was given, but he was followed with serial radiographs.[ncbi.nlm.nih.gov]
  • Semi-segmented and incarcerated hemivertebrae usually do not require treatment. Fully segmented non-incarcerated hemivertebrae may require prophylactic treatment to prevent significant deformity.[ncbi.nlm.nih.gov]
  • The surgical treatments included hemiepiphysiodesis or in situ fusion (group 1), instrumented fusion without hemivertebra excision (group 2), or instrumented hemivertebra excision (group 3).[ncbi.nlm.nih.gov]

Prognosis

  • Hemivertebrae, which are the most frequent cause of congenital scoliosis, pose a challenge in terms of prognosis and therapy.[ncbi.nlm.nih.gov]
  • Treatment and prognosis The prognosis can be variable dependent on the type of segmentation anomaly, from being a progressive to a non-progressive deformity. The strongest negative impact is when a hemivertebra occurs at the lumbosacral level 7.[radiopaedia.org]
  • Prognosis The prognosis can be variable dependant on the type from being a progressive to non progressive deformity. The strongest negative impact is when a hemivertebra occurs at the lumbo-sacral level 7.[operativeneurosurgery.com]
  • In view of the poor prognosis of surgical intervention he was fitted with an Jewett brace so that further neurological impairment was avoided.[e-arm.org]
  • Other types of hemivertebra, especially those involving unbalanced congenital scoliosis, usually progress markedly with growth and have a relatively poor prognosis unless early spinal fusion prevents further spinal curvature.[strongbones.in]

Etiology

  • The etiology of congenital scoliosis remains unclear. Both a genetic basis and environmental influences have been postulated. A few isolated reports of discordant spinal anomalies in twins exist.[ncbi.nlm.nih.gov]
  • PubMed Central View Article PubMed Google Scholar Hensinger RN: Congenital scoliosis: etiology and associations. Spine (Phila Pa 1976). 2009, 34 (17): 1745-1750. 10.1097/BRS.0b013e3181abf69e.[scoliosisjournal.biomedcentral.com]
  • Karger AG, Basel References Wynne-Davies R: Congenital vertebral anomalies: Etiology and relationship to spina bifida cystica. J Med Genet 1975;12:280–288. Moore KL: The Developing Human ed 2. Philadelphia, Saunders, 1983, p 217.[karger.com]

Epidemiology

  • A cervical location is rare and even rarer as a cause of cervical subluxation in flexion and extension (for which only one previous case has been found). see cervical hemivertebra Epidemiology The estimated incidence is at 0.3 per 1000 live births 2.[operativeneurosurgery.com]
  • Descriptive epidemiology of hemivertebrae, Hawaii, 1986–2002. Congenit Anom (Kyoto) 2006; 46: 172–176. 4. Moore KL. The developing human. Fourth edn. Philadelphia: W. B. Saunders Co., 1988. Copyright 2014 ISUOG. Published by John Wiley & Sons Ltd.[docksci.com]
  • Descriptive epidemiology of hemivertebrae, Hawaii, 1986–2002. Congenit Anom. 2006:46172–46176. [ PubMed ] [ Google Scholar ] 17. Connor JM, Conner AN, Connor RAC, Tolmie JL, Yeung B, Goudie D. Genetic aspects of early childhood scoliosis.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Stay current on the latest standards in medical care thanks to extensive updates, including new chapters on Spinal Cord Stimulation and Implantable Drug Delivery Systems, Special surgical Techniques for the Growing Spine, Pathophysiology of Degenerative[books.google.ro]

Prevention

  • Fully segmented non-incarcerated hemivertebrae may require prophylactic treatment to prevent significant deformity.[ncbi.nlm.nih.gov]
  • In the past, treatment has focused on prevention of deformity progression in growing children. Little has been written about congenital scoliosis presenting in adulthood.[ncbi.nlm.nih.gov]
  • Surgery should be performed as early as possible to avert the development of severe local deformities and prevent secondary structural deformities that would require a more extensive fusion later.[ncbi.nlm.nih.gov]
  • Surgical stabilization is required for preventing recurrent deformity and restoration of spinal balance. A new surgical technique for spinal correction and stabilization in congenital scoliosis is described.[ncbi.nlm.nih.gov]
  • 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.[ncbi.nlm.nih.gov]

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