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Walters S, Barkham B, Bishop T, Bernard J, Coroyannakis C, Thilaganathan B, Lui DF. Fetal Scoliosis: Natural History and Outcomes. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202406000-00002. [PMID: 38996079 PMCID: PMC11132347 DOI: 10.5435/jaaosglobal-d-24-00093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/22/2024] [Indexed: 07/14/2024]
Abstract
INTRODUCTION Scoliosis can be detected on prenatal ultrasonography and may be associated with structural and syndromic abnormalities. Associations and pregnancy outcomes related to the prenatal diagnosis of scoliosis are poorly understood. METHODS A retrospective cohort study was undertaken at a tertiary referral center in London. Referred cases with spinal deformities between 1997 and 2021 were identified from the prenatal ultrasonography database. Outcomes were ascertained from the database and electronic notes. RESULTS One hundred twenty-three cases of fetal spinal deformities (scoliosis, kyphosis, or kyphoscoliosis) were identified from a referral population of 660,000 pregnancies, giving an incidence of approximately 0.2 per 1000 fetuses. Fifty-eight live births (47.2%) and 65 cases (52.8%) of fetal or neonatal demise or termination were observed. Most live births were isolated spinal deformities with a good postnatal outcome (n = 35, 60.3%). The commonest syndromic diagnosis in this group was VACTERL association (n = 7, 12.1%). Most cases of fetal loss were associated with severe malformations, most commonly spina bifida, body stalk anomaly and amniotic band sequence, or chromosomal abnormalities, except in 2 cases (3.1%). CONCLUSIONS This is the largest reported cases series to date of prenatally diagnosed fetal spinal deformity. This confirms that fetal scoliosis and associated vertebral abnormalities are underdiagnosed prenatally, with the reported incidence (0.2 per 1000) lower than the recognized incidence of congenital scoliosis (1 in 1,000). The concurrent finding of severe malformations was strongly associated with fetal loss. When an isolated finding, most fetal spinal deformities had a good postnatal outcome, while 1:8 live births were diagnosed with VACTERL association.
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Affiliation(s)
- Samuel Walters
- From the Department of Trauma and Orthopaedic Surgery, (Mr. Walters, Mr. Barkham, Mr. Bishop, Mr. Bernard, Mr. Lui), and the Fetal Medicine Unit (Ms. Coroyannakis, Prof. Thilaganathan), St. George's University Hospital, London, United Kingdom
| | - Ben Barkham
- From the Department of Trauma and Orthopaedic Surgery, (Mr. Walters, Mr. Barkham, Mr. Bishop, Mr. Bernard, Mr. Lui), and the Fetal Medicine Unit (Ms. Coroyannakis, Prof. Thilaganathan), St. George's University Hospital, London, United Kingdom
| | - Tim Bishop
- From the Department of Trauma and Orthopaedic Surgery, (Mr. Walters, Mr. Barkham, Mr. Bishop, Mr. Bernard, Mr. Lui), and the Fetal Medicine Unit (Ms. Coroyannakis, Prof. Thilaganathan), St. George's University Hospital, London, United Kingdom
| | - Jason Bernard
- From the Department of Trauma and Orthopaedic Surgery, (Mr. Walters, Mr. Barkham, Mr. Bishop, Mr. Bernard, Mr. Lui), and the Fetal Medicine Unit (Ms. Coroyannakis, Prof. Thilaganathan), St. George's University Hospital, London, United Kingdom
| | - Christina Coroyannakis
- From the Department of Trauma and Orthopaedic Surgery, (Mr. Walters, Mr. Barkham, Mr. Bishop, Mr. Bernard, Mr. Lui), and the Fetal Medicine Unit (Ms. Coroyannakis, Prof. Thilaganathan), St. George's University Hospital, London, United Kingdom
| | - Basky Thilaganathan
- From the Department of Trauma and Orthopaedic Surgery, (Mr. Walters, Mr. Barkham, Mr. Bishop, Mr. Bernard, Mr. Lui), and the Fetal Medicine Unit (Ms. Coroyannakis, Prof. Thilaganathan), St. George's University Hospital, London, United Kingdom
| | - Darren F. Lui
- From the Department of Trauma and Orthopaedic Surgery, (Mr. Walters, Mr. Barkham, Mr. Bishop, Mr. Bernard, Mr. Lui), and the Fetal Medicine Unit (Ms. Coroyannakis, Prof. Thilaganathan), St. George's University Hospital, London, United Kingdom
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Powel JE, Sham CE, Spiliopoulos M, Ferreira CR, Rosenthal E, Sinkovskaya ES, Brown S, Jelin AC, Al-Kouatly HB. Genetics of non-isolated hemivertebra: A systematic review of fetal, neonatal, and infant cases. Clin Genet 2022; 102:262-287. [PMID: 35802600 PMCID: PMC9830455 DOI: 10.1111/cge.14188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 01/12/2023]
Abstract
Hemivertebra is a congenital vertebral malformation caused by unilateral failure of formation during embryogenesis that may be associated with additional abnormalities. A systematic review was conducted to investigate genetic etiologies of non-isolated hemivertebra identified in the fetal, neonatal, and infant periods using PubMed, Cochrane database, Ovid Medline, and ClinicalTrials.gov from inception through May 2022 (PROSPERO ID CRD42021229576). The Human Phenotype Ontology database was accessed May 2022. Studies were deemed eligible for inclusion if they addressed non-isolated hemivertebra or genetic causes of non-isolated hemivertebra identified in the fetal, neonatal, or infant periods. Cases diagnosed clinically without molecular confirmation were included. Systematic review identified 23 cases of non-isolated hemivertebra with karyotypic abnormalities, 2 cases due to microdeletions, 59 cases attributed to single gene disorders, 18 syndromic cases without known genetic etiology, and 14 cases without a known syndromic association. The Human Phenotype Ontology search identified 49 genes associated with hemivertebra. Non-isolated hemivertebra is associated with a diverse spectrum of cytogenetic abnormalities and single gene disorders. Genetic syndromes were notably common. Frequently affected organ systems include musculoskeletal, cardiovascular, central nervous system, genitourinary, gastrointestinal, and facial dysmorphisms. When non-isolated hemivertebra is identified on prenatal ultrasound, the fetus must be assessed for associated anomalies and genetic counseling is recommended.
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Affiliation(s)
- Jennifer E. Powel
- Division of Maternal Fetal Medicine, Department of Obstetrics Gynecology, & Women’s Health, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Catherine E. Sham
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michail Spiliopoulos
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, University of Miami, Miami, Florida, USA
| | - Carlos R. Ferreira
- Section on Human Biochemical Genetics, Medical Genetics Branch, National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Emily Rosenthal
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Elena S. Sinkovskaya
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Shannon Brown
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Angie C. Jelin
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Huda B. Al-Kouatly
- Division of Maternal Fetal Medicine, Department of Obstetrics & Gynecology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
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Tang X, Bai G, Wang H, Guo F, Yin H. A comparison of the accuracy of fetal magnetic resonance imaging and ultrasonography for the diagnosis of fetal congenital malformations of the spine and spinal cord. Prenat Diagn 2022; 42:1295-1302. [PMID: 35808906 DOI: 10.1002/pd.6209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 11/08/2022]
Abstract
PURPOSE To determine the diagnostic value of fetal magnetic resonance imaging (MRI) for congenital spine/spinal cord malformations. METHODS This single-center retrospective study included 120 cases of fetal spine/spinal cord abnormalities detected using fetal ultrasonography (US) and further examined by fetal MRI between 2016 and 2020. Cases were divided into three groups (congenital spine, spinal cord, and spine + spinal cord malformations) based on US assessment. We analyzed the accuracy of fetal US and MRI relative to postnatal imaging. RESULTS The diagnostic accuracy of fetal MRI for fetal spinal cord, spine, and spine + spinal cord malformations was 86.2% (25/29), 89.4% (42/47), and 86.3% (38/44), respectively, and the corresponding rates for fetal US were 51.7% (15/29), 87.2% (41/47), and 68.2% (30/44). The diagnostic accuracy did not differ between fetal MRI and US for congenital spine malformations (P > 0.05); for congenital spinal cord malformations and congenital spine+spinal cord malformations, the diagnostic accuracy was significantly higher for fetal MRI than for fetal US (P < 0.05). CONCLUSIONS Fetal MRI is effective in the assessment of congenital spine/spinal cord malformations. It can yield information that supplements US findings, especially for congenital spinal cord malformations, and can improve the accuracy of fetal diagnosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Xing Tang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Guoyan Bai
- Department of Clinical Laboratory, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, PR China
| | - Hong Wang
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Fan Guo
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Hong Yin
- Department of Radiology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, PR China
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Guo SS, Au TYK, Wynn S, Aszodi A, Chan D, Fässler R, Cheah KSE. β1 Integrin regulates convergent extension in mouse notogenesis, ensures notochord integrity and the morphogenesis of vertebrae and intervertebral discs. Development 2020; 147:dev192724. [PMID: 33051257 DOI: 10.1242/dev.192724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/01/2020] [Indexed: 12/17/2022]
Abstract
The notochord drives longitudinal growth of the body axis by convergent extension, a highly conserved developmental process that depends on non-canonical Wnt/planar cell polarity (PCP) signaling. However, the role of cell-matrix interactions mediated by integrins in the development of the notochord is unclear. We developed transgenic Cre mice, in which the β1 integrin gene (Itgb1) is ablated at E8.0 in the notochord only or in the notochord and tail bud. These Itgb1 conditional mutants display misaligned, malformed vertebral bodies, hemi-vertebrae and truncated tails. From early somite stages, the notochord was interrupted and displaced in these mutants. Convergent extension of the notochord was impaired with defective cell movement. Treatment of E7.25 wild-type embryos with anti-β1 integrin blocking antibodies, to target node pit cells, disrupted asymmetric localization of VANGL2. Our study implicates pivotal roles of β1 integrin for the establishment of PCP and convergent extension of the developing notochord, its structural integrity and positioning, thereby ensuring development of the nucleus pulposus and the proper alignment of vertebral bodies and intervertebral discs. Failure of this control may contribute to human congenital spine malformations.
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Affiliation(s)
- Shiny Shengzhen Guo
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Max Planck Institute of Biochemistry, Department of Molecular Medicine, 82152 Martinsried, Germany
| | - Tiffany Y K Au
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Sarah Wynn
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Attila Aszodi
- Department of General, Trauma and Reconstructive Surgery, Munich University Hospital, Ludwig-Maximilians-University, Fraunhoferstraβe 20, 82152 Planegg-Martinsried, Germany
| | - Danny Chan
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Reinhard Fässler
- Max Planck Institute of Biochemistry, Department of Molecular Medicine, 82152 Martinsried, Germany
| | - Kathryn S E Cheah
- School of Biomedical Sciences, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
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Yulia A, Pawar S, Chelemen O, Ushakov F, Pandya PP. Fetal Hemivertebra at 11 to 14 Weeks' Gestation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1857-1863. [PMID: 32297336 DOI: 10.1002/jum.15280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 03/14/2020] [Accepted: 03/17/2020] [Indexed: 06/11/2023]
Abstract
Hemivertebra appears as an angulation of the spine on a coronal section. We evaluated the prevalence of chromosomal defects and outcome of fetuses with hemivertebra detected in the first trimester over a 9-year period in a single tertiary referral unit. There were 10 cases; 9 had other anomalies. Seven couples opted for termination of pregnancy. One pregnancy ended in fetal demise at 16 weeks, and the 2 isolated cases continued the pregnancy with delivery at term. A karyotype analysis was performed in 8 fetuses: 5 found to be euploid and 3 having trisomy 18. Comprehensive ultrasound screening allows early prenatal detection and appropriate counseling.
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Affiliation(s)
- Angela Yulia
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, England
| | - Sona Pawar
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, England
| | - Oana Chelemen
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, England
| | - Fred Ushakov
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, England
| | - Pranav P Pandya
- Fetal Medicine Unit, Elizabeth Garrett Anderson Wing, University College London Hospital, London, England
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Xu T, Wang X, Yu H, Zhao F. Twin pregnancy complicated with congenital Hemivertebra: report of two cases and literature review. BMC Pregnancy Childbirth 2020; 20:479. [PMID: 32819302 PMCID: PMC7441669 DOI: 10.1186/s12884-020-03177-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/14/2020] [Indexed: 12/03/2022] Open
Abstract
Background Hemivertebra deformity, involving one or multiple vertebral bodies, is one of the important causes of congenital scoliosis. Congenital fetal hemivertebrae could be diagnosed by ultrasonography and confirmed by fetal magnetic resonance imaging during pregnancy. However, reports of hemivertebrae in twins during the perinatal period are very rare. Case presentation We report two cases of congenital fetal hemivertebrae, each affecting one fetus in a dichorionic diamniotic (DCDA) twin pregnancy. We have also conducted a literature review of its prenatal screening, diagnosis, management, and outcomes. These two cases of congenital fetal hemivertebrae in one fetus of a DCDA twin were both initially found by ultrasonography and confirmed by fetal magnetic resonance imaging (MRI). One couple chose selective termination of the hemivertebrae fetus after they were extensively counseled by the multidisciplinary team regarding the treatment and prognosis of the hemivertebrae twin, and a healthy baby weighing 2320 g was delivered at the 37+ 1 gestational week. The other couple decided to continue the twin pregnancy and gave birth to two living newborns weighing 2580 g and 2060 g at 37+ 1 gestational weeks. These three babies were all in good health during follow-up. Conclusions Based on our center’s experience, comprehensive ultrasonography is necessary for early prenatal diagnosis of this condition. In addition, fetal MRI will confirm the diagnosis of hemivertebrae and provide parents with helpful information for their decision about the fate of the affected fetus.
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Affiliation(s)
- Tingting Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaodong Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Haiyan Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
| | - Fumin Zhao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China. .,Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, China.
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Nikova A, Chatzipaulou V, Malkots B, Mustafa RM, Valsamidou C, Birbilis T. Correlation between Age and Surgical Approach for Thoracic and Lumbar Hemivertebra. INDIAN JOURNAL OF NEUROSURGERY 2020. [DOI: 10.1055/s-0040-1710103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Objective Hemivertebra (HV) is a congenital defect of the formation of the spinal vertebra, which can result in scoliosis or kyphosis along with the related symptomatology of spine deformity. More often than not, it is linked to other abnormalities and requires attention. Its management is surgical and it is of great importance for the physician to choose the right approach at the right time, due to its deteriorative prognosis.
Methods Due to the interest of the subject, the authors investigated the world literature between 1990 and 2018 and found 45 articles, reporting thoracic, thoracolumbar, and lumbar HV in children and its postsurgical outcome, aiming to show whether the approaches are equal in terms of the final outcome.
Results The chosen surgical method depends much on the level of the pathology. Despite this fact, after analyzing the included data, we found that the surgical techniques are unequal with regard to the purpose of achieving improvement. Age, caudal and cranial curves, segmental kyphosis, and scoliosis are factors playing a major role in this.
Conclusion If not treated, HV leads to deterioration and dysfunction. The most optimal result, however, is achieved only when the surgical approach is applied according to age and rest of the accompanying factors, which should be considered in future management planning.
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Affiliation(s)
- Alexandrina Nikova
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Varvara Chatzipaulou
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Belkis Malkots
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Reichan Molla Mustafa
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Christina Valsamidou
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
| | - Theodosis Birbilis
- Department of Neurosurgery, Democritus University of Thrace Medical School, Alexandroupolis, Greece
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Mackel CE, Jada A, Samdani AF, Stephen JH, Bennett JT, Baaj AA, Hwang SW. A comprehensive review of the diagnosis and management of congenital scoliosis. Childs Nerv Syst 2018; 34:2155-2171. [PMID: 30078055 DOI: 10.1007/s00381-018-3915-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 07/11/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE To provide the reader with a comprehensive but concise understanding of congenital scoliosis METHODS: We have undertaken to summarize available literature on the pathophysiology, epidemiology, and management of congenital scoliosis. RESULTS Congenital scoliosis represents 10% of pediatric spine deformity and is a developmental error in segmentation, formation, or a combination of both leading to curvature of the spine. Treatment options are complicated by balancing growth potential with curve severity. Often associated abnormalities of cardiac, genitourinary, or intraspinal systems are concurrent and should be evaluated as part of the diagnostic work-up. Management balances the risk of progression, growth potential, lung development/function, and associated risks. Surgical treatment options involve growth-permitting systems or fusions. CONCLUSION Congenital scoliosis is a complex spinal problem associated with many other anomalous findings. Treatment options are diverse but enable optimization of management and care of these children.
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Affiliation(s)
- Charles E Mackel
- Department of Neurosurgery, Tufts Medical Center and Floating Hospital for Children, 800 Washington St, Boston, 02111, MA, USA
| | - Ajit Jada
- Department of Neurological Surgery, Weill Cornell Medical College, Box 99, 525 E 68th St, New York, 10065, NY, USA
| | - Amer F Samdani
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad Street, Philadelphia, PA, 19140, USA
| | - James H Stephen
- Department of Neurosurgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, 19104, PA, USA
| | - James T Bennett
- Department of Orthopaedic Surgery, Lewis Katz School of Medicine at Temple University, 3500 N Broad St, Philadelphia, 19140, PA, USA
| | - Ali A Baaj
- Department of Neurological Surgery, Weill Cornell Medical College, Box 99, 525 E 68th St, New York, 10065, NY, USA
| | - Steven W Hwang
- Shriners Hospitals for Children-Philadelphia, 3551 N Broad Street, Philadelphia, PA, 19140, USA.
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Wen Y, Xiang G, Liang X, Tong X. The Clinical Value of Prenatal 3D Ultrasonic Diagnosis on Fetus Hemivertebra Deformity- A Preliminary Study. Curr Med Imaging 2018; 14:139-142. [PMID: 29399013 PMCID: PMC5759173 DOI: 10.2174/1573405612666161024160609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/05/2016] [Accepted: 09/15/2016] [Indexed: 12/19/2022]
Abstract
Objective: The present study is planned to discuss the clinical value of prenatal 3D ultra-sonic diagnosis on fetus hemivertebra deformity through the retrospective analysis of clinical data of fetus hemivertebra deformity. Methods: Selected 9 fetus hemivertebra deformity cases, which have been admitted to our hospital during the period from January, 2010 to January, 2016 as study samples, and analyzed their 2D and 3D ultrasonic examination data. Results: 4 cases of the fetus hemivertebra deformity occurred at lumbar vertebra, 3 cases at thoracic vertebra, and 2 cases at thoracolumbar vertebra. There were scoliosis and opened spine bifida (OSB). In 7 cases, there was absence of ribs in fetus. The 2D ultrasonic image showed that: The echo at the center of fetus vertebral arch lesion was blurred or lost. The coronal section showed the deformity of the spine. There was obvious loss of the ossification center. From the cross section, we could see that the vertebral body of the fetus was shrinking and the edges were relatively blurred. The 3D ultrasonic image showed that: the echo at the ossification center of the fetus vertebra was relatively blurred, or even lost. The image also indicated scoliosis deformity of the spine. The vertebral body lesion could be accurately located. Conclusion: 9 cases of fetus hemivertebra deformity have been detected through examination. Labor inductions have been carried out after getting the permission from the family members. The X-ray examination of the fetus after labor induction showed that the diagnosis was correct. Prenatal ultra-sonic examination holds strong potential for the diagnosis of fetus hemivertebra deformity quite early and deserves further clinical evaluation with large sample size.
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Affiliation(s)
- Yanting Wen
- Ultrasound Department, Fifth People's Hospital of Chengdu, Chengdu 611130, Sichuan, China
| | - Guishuang Xiang
- Ultrasound Department, Fifth People's Hospital of Chengdu, Chengdu 611130, Sichuan, China
| | - Xiaoqiu Liang
- Ultrasound Department, Fifth People's Hospital of Chengdu, Chengdu 611130, Sichuan, China
| | - Xiaoqian Tong
- Ultrasound Department, Fifth People's Hospital of Chengdu, Chengdu 611130, Sichuan, China
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Digital image analysis of ossification centers in the axial dens and body in the human fetus. Surg Radiol Anat 2016; 38:1195-1203. [PMID: 27130209 PMCID: PMC5104797 DOI: 10.1007/s00276-016-1679-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/22/2016] [Indexed: 11/23/2022]
Abstract
Purposes The detailed understanding of the anatomy and timing of ossification centers is indispensable in both determining the fetal stage and maturity and for detecting congenital disorders. This study was performed to quantitatively examine the odontoid and body ossification centers in the axis with respect to their linear, planar and volumetric parameters. Methods Using the methods of CT, digital image analysis and statistics, the size of the odontoid and body ossification centers in the axis in 55 spontaneously aborted human fetuses aged 17–30 weeks was studied. Results With no sex difference, the best fit growth dynamics for odontoid and body ossification centers of the axis were, respectively, as follows: for transverse diameter y = −10.752 + 4.276 × ln(age) ± 0.335 and y = −10.578 + 4.265 × ln(age) ± 0.338, for sagittal diameter y = −4.329 + 2.010 × ln(age) ± 0.182 and y = −3.934 + 1.930 × ln(age) ± 0.182, for cross-sectional area y = −7.102 + 0.520 × age ± 0.724 and y = −7.002 + 0.521 × age ± 0.726, and for volume y = −37.021 + 14.014 × ln(age) ± 1.091 and y = −37.425 + 14.197 × ln(age) ± 1.109. Conclusions With no sex differences, the odontoid and body ossification centers of the axis grow logarithmically in transverse and sagittal diameters, and in volume, while proportionately in cross-sectional area. Our specific-age reference data for the odontoid and body ossification centers of the axis may be relevant for determining the fetal stage and maturity and for in utero three-dimensional sonographic detecting segmentation anomalies of the axis.
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Henderson P, Desai IP, Pettit K, Benke S, Brouha SS, Romine LE, Beeker K, Chuang NA, Yaszay B, Van Houten L, Pretorius DH. Evaluation of Fetal First and Second Cervical Vertebrae: Normal or Abnormal? JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:527-536. [PMID: 26887450 DOI: 10.7863/ultra.14.12044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 06/27/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To use 3-dimensional sonographic volumes to evaluate the variable appearance of the normal fetal cervical spine and craniocervical junction, which if unrecognized may lead to misdiagnosis of malalignment at the first and second cervical vertebrae (C1 and C2). METHODS Three-dimensional sonographic volumes of the fetal cervical spine were obtained from 24 fetuses at gestational ages between 12 weeks 6 days and 35 weeks 1 day. The volumes were reviewed on 4-dimensional software, and the vertebral level was determined by labeling the first rib-bearing vertebra as the first thoracic vertebra. The ossification centers of the cervical spine and occipital condyles were then labeled accordingly and evaluated for alignment and structure by rotating the volumes in oblique planes. The appearance on multiplanar images was assessed for possible perceived anomalies, including malalignment, particularly at the C1 and C2 levels. Evidence of head rotation was correlated with the presence of possible malalignment at C1-C2. Head rotation was identified in the axial plane by measuring the angle of the anteroposterior axis of C1 to the anteroposterior axis of C2. RESULTS Of the 24 fetuses, 16 had adequate quality to assess the entire cervical spine and craniocervical junction. All 16 cases showed an osseous component of C1 that did not align directly with C2 on some of the multiplanar images when the volumes were rotated, which could lead to suspected diagnosis of spinal malalignment or a segmental abnormality, as occurred in 2 clinical cases in our practice. All 16 cases showed at least some degree of head rotation, ranging from 2° to 36°, which may possibly explain the apparent malalignment. The lateral offset from C1 to C2 ranged from 0.0 to 3.3 mm. CONCLUSIONS The normal C1 and C2 ossification centers may appear to be malaligned due to normal offsetting (lateral displacement) of C1 on C2. An understanding of the normal development of the cervical spine is important in assessing spinal anatomy.
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Affiliation(s)
- Patrick Henderson
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Ishita P Desai
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Kate Pettit
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Sarah Benke
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Sharon S Brouha
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Lorene E Romine
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Krissa Beeker
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Nathaniel A Chuang
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Burt Yaszay
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Laurie Van Houten
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.)
| | - Dolores H Pretorius
- Departments of Maternal-Fetal Care and Genetics (P.H., K.P., L.E.R., K.B., L.V.H., D.H.P.), Radiology (P.H., S.S.B., L.E.R., D.H.P.), and Reproductive Medicine (K.P.), University of California, San Diego, California USA; New York Medical College, Valhalla, New York USA (I.P.D.); University of California, Irvine, California USA (S.B.); and University of California, Rady Children's Hospital, San Diego, California USA (N.A.C., B.Y.).
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12
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Basude S, McDermott L, Newell S, Wreyford B, Denbow M, Hutchinson J, Abdel-Fattah S. Fetal hemivertebra: associations and perinatal outcome. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:434-438. [PMID: 24789522 DOI: 10.1002/uog.13401] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/11/2014] [Accepted: 04/22/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To assess the accuracy of antenatal diagnosis of hemivertebra, to quantify the association with coexisting anomalies and to determine the perinatal outcome. METHOD This was a retrospective observational study of all cases of suspected fetal or neonatal hemivertebra identified via the UK Southwest Congenital Anomaly Register (SWCAR) between 2002 and 2012. RESULTS From a total of 88 cases of hemivertebra identified during the study period, data were obtained for 67 of them: 45 (10 isolated and 35 with coexisting anomalies) cases were suspected antenatally and 22 (10 isolated and 12 with coexisting anomalies) were diagnosed postnatally. Of the cases detected postnatally, five (four with coexisting anomalies) were unsuspected and diagnosed at postmortem examination. The most commonly associated anomalies included additional skeletal abnormalities (n = 16), genitourinary abnormalities (n = 10), VATER/VACTERL association (n = 5), cardiac abnormalities (n = 4) and central nervous system abnormalities (n = 4). In cases with coexisting anomalies there was a 48% fetal/neonatal loss, compared to 19% in cases with isolated hemivertebra. CONCLUSIONS Although antenatal diagnosis of hemivertebra was accurate, a third of the cases were diagnosed only postnatally. 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. These data should be useful in providing additional information for counseling when a diagnosis of hemivertebra is made.
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Affiliation(s)
- S Basude
- Department of Obstetrics and Fetal Medicine, St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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13
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Szpinda M, Baumgart M, Szpinda A, Woźniak A, Mila-Kierzenkowska C. Cross-sectional study of C1-S5 vertebral bodies in human fetuses. Arch Med Sci 2015; 11:174-89. [PMID: 25861306 PMCID: PMC4379359 DOI: 10.5114/aoms.2013.37086] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 10/24/2012] [Accepted: 01/16/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Knowledge on the normative spinal growth is relevant in the prenatal detection of its abnormalities. The present study determines the height, transverse and sagittal diameters, cross sectional area, and volume of individual C1-S5 vertebral bodies. MATERIAL AND METHODS Using the methods of computed tomography (CT), digital image analysis, and statistics, the size of C1-S5 vertebral bodies in 55 spontaneously aborted human fetuses aged 17-30 weeks was examined. RESULTS All the 5 examined parameters changed significantly with gestational age (p < 0.01). The mean height of vertebral bodies revealed an increase from the atlas (2.39 ±0.54 mm) to L2 (4.62 ±0.97 mm), stabilized through L3-L4 (4.58 ±0.92 mm, 4.61 ±0.84 mm), and then was decreasing to S5 (0.43 ±1.06 mm). The mean transverse diameter of vertebral bodies was increasing from the atlas (1.20 ±1.96 mm) to L1 (6.24 ±1.46 mm), so as to stabilize through L2-L3 (6.12 ±1.65, 6.12 ±1.61 mm), and finally was decreasing to S5 (0.26 ±0.96 mm). There was an increase in sagittal diameter of vertebral bodies from the atlas (0.82 ±1.34 mm) to T7 (4.76 ±0.85 mm), its stabilization for T8-L4 (4.73 ±0.86 mm, 4.71 ±1.02 mm), and then a decrease in values to S5 (0.21 ±0.75 mm) was observed. The values for cross-sectional area of vertebral bodies were increasing from the atlas (2.95 ±5.25 mm(2)) to L3 (24.92 ±11.07 mm(2)), and then started decreasing to S5 (0.48 ±2.09 mm(2)). The volumetric growth of vertebral bodies was increasing from the atlas (8.60 ±16.40 mm(3)) to L3 (122.16 ±74.73 mm(3)), and then was decreasing to S5 (1.60 ±7.00 mm(3)). CONCLUSIONS There is a sharp increase in size of fetal vertebral bodies between the atlas and the axis, and a sharp decrease in size within the sacral spine. In human fetuses the vertebral body growth is characterized by maximum values in sagittal diameter for T7, in transverse diameter for L1, in height for L2, and in both cross-sectional area and volume for L3.
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Affiliation(s)
- Michał Szpinda
- Department of Normal Anatomy, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
| | - Mariusz Baumgart
- Department of Normal Anatomy, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
| | - Anna Szpinda
- Department of Normal Anatomy, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
| | - Alina Woźniak
- Department of Medical Biology, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
| | - Celestyna Mila-Kierzenkowska
- Department of Medical Biology, Nicolaus Copernicus University, Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
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14
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Szpinda M, Baumgart M, Szpinda A, Woźniak A, Mila-Kierzenkowska C. New patterns of the growing L3 vertebra and its 3 ossification centers in human fetuses - a CT, digital, and statistical study. Med Sci Monit Basic Res 2013; 19:169-80. [PMID: 23778313 PMCID: PMC3692385 DOI: 10.12659/msmbr.883956] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background This study describes reference data for L3 vertebra and its 3 ossification centers at varying gestational ages. Material/Methods Using CT, digital-image analysis and statistics, the growth of L3 vertebra and its 3 ossification centers in 55 spontaneously aborted human fetuses aged 17–30 weeks was examined. Results Neither sex nor right-left significant differences were found. The height and transverse and sagittal diameters of the L3 vertebral body increased logarithmically. Its cross-sectional area followed linearly, whereas its volume increased parabolically. The transverse and sagittal diameters of the ossification center of the L3 vertebral body varied logarithmically, but its cross-sectional area and volume grew linearly. The ossification center-to-vertebral body volume ratio gradually declined with age. The neural ossification centers increased logarithmically in length and width, and proportionately in cross-sectional area and volume. Conclusions With no sex differences, the growth dynamics of the L3 vertebral body follow logarithmically in height, sagittal and transverse diameters, linearly (in cross-sectional area), and parabolically (in volume). The growth dynamics of the 3 ossification centers of the L3 vertebra follow logarithmically in transverse and sagittal diameters, and linearly (in cross-sectional area and volume). The age-specific reference intervals of the L3 vertebra and its 3 ossification centers present the normative values of clinical importance in the diagnosis of congenital spinal defects.
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Affiliation(s)
- Michał Szpinda
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland.
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15
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Wei Q, Cai A, Wang X, Xie L, Wang B, Wang X. Value of 3-dimensional sonography for prenatal diagnosis of vertebral formation failure. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:595-607. [PMID: 23525384 DOI: 10.7863/jum.2013.32.4.595] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVES The purposes of this study were to explore the value of 3-dimensional sonography for diagnosis of vertebral formation failure in the developing fetus and to formulate antenatal sonographic diagnostic criteria for suspected vertebral formation failure based on a comparison of sonographic characteristics of the disorder with normal sonographic findings and other imaging data. METHODS This study included sonographic data from 30 healthy fetuses and 13 fetuses suspected to have vertebral formation failure. Three-dimensional reconstruction of sagittal sections of the physiologic curves of the cervicothoracic and lumbosacral regions of the healthy fetuses was performed, and reconstruction was also performed on selected areas of interest when vertebral malformation was suspected. Stored data were analyzed, and a comparison with other image data was performed using various methods. RESULTS Three-dimensional reconstruction was more suitable for fetal spinal sonography among the 30 healthy fetuses, and it was particularly superior in detecting the positions of spines with evident physiologic curvature. The images revealed suspected vertebral formation failure in 13 cases, and the confirmed findings included 7 cases of hemivertebrae, 2 cases of butterfly vertebrae, 2 cases of mixed malformations (butterfly vertebra and hemivertebra), and 1 case of a coronal cleft vertebra. One case was lost to follow-up. The sonographic characteristics were definite, and there were evident differences from the sonograms of spina bifida. CONCLUSIONS Three-dimensional sonography is helpful for detection of vertebral formation failure in the developing fetus and might provide prognostic information with the potential to ameliorate the progressive spinal deformities that can result from embryonic vertebral formation failure.
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Affiliation(s)
- Qiuju Wei
- Department of Ultrasound, Shengjing Hospital, China Medical University, 36 Sanhao St, 110004 Shenyang, Liaoning, China
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Szpinda M, Baumgart M, Szpinda A, Woźniak A, Mila-Kierzenkowska C, Dombek M, Kosiński A, Grzybiak M. Morphometric study of the T6 vertebra and its three ossification centers in the human fetus. Surg Radiol Anat 2013; 35:901-16. [PMID: 23543237 PMCID: PMC3835927 DOI: 10.1007/s00276-013-1107-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 03/12/2013] [Indexed: 11/29/2022]
Abstract
Purpose Knowledge on the normative growth of the spine is critical in the prenatal detection of its abnormalities. We aimed to study the size of T6 vertebra in human fetuses with the crown-rump length of 115–265 mm. Materials and methods Using the methods of computed tomography (Biograph mCT), digital image analysis (Osirix 3.9) and statistics, the normative growth of the T6 vertebral body and the three ossification centers of T6 vertebra in 55 spontaneously aborted human fetuses (27 males, 28 females) aged 17–30 weeks were studied. Results Neither male–female nor right–left significant differences were found. The height, transverse, and sagittal diameters of the T6 vertebral body followed natural logarithmic functions as y = −4.972 + 2.732 × ln(age) ± 0.253 (R2 = 0.72), y = −14.862 + 6.426 × ln(age) ± 0.456 (R2 = 0.82), and y = −10.990 + 4.982 × ln(age) ± 0.278 (R2 = 0.89), respectively. Its cross-sectional area (CSA) rose proportionately as y = −19.909 + 1.664 × age ± 2.033 (R2 = 0.89), whereas its volumetric growth followed the four-degree polynomial function y = 19.158 + 0.0002 × age4 ± 7.942 (R2 = 0.93). The T6 body ossification center grew logarithmically in both transverse and sagittal diameters as y = −14.784 + 6.115 × ln(age) ± 0.458 (R2 = 0.81) and y = −12.065 + 5.019 × ln(age) ± 0.315 (R2 = 0.87), and proportionately in both CSA and volume like y = −15.591 + 1.200 × age ± 1.470 (R2 = 0.90) and y = −22.120 + 1.663 × age ± 1.869 (R2 = 0.91), respectively. The ossification center-to-vertebral body volume ratio was gradually decreasing with age. On the right and left, the neural ossification centers revealed the following models: y = −15.188 + 6.332 × ln(age) ± 0.629 (R2 = 0.72) and y = −15.991 + 6.600 × ln(age) ± 0.629 (R2 = 0.74) for length, y = −6.716 + 2.814 × ln(age) ± 0.362 (R2 = 0.61) and y = −7.058 + 2.976 × ln(age) ± 0.323 (R2 = 0.67) for width, y = −5.665 + 0.591 × age ± 1.251 (R2 = 0.86) and y = −11.281 + 0.853 × age ± 1.653 (R2 = 0.78) for CSA, and y = −9.279 + 0.849 × age ± 2.302 (R2 = 0.65) and y = −16.117 + 1.155 × age ± 1.832 (R2 = 0.84) for volume, respectively. Conclusions Neither sex nor laterality differences are found in the morphometric parameters of evolving T6 vertebra and its three ossification centers. The growth dynamics of the T6 vertebral body follow logarithmically for its height, and both sagittal and transverse diameters, linearly for its CSA, and four-degree polynomially for its volume. The three ossification centers of T6 vertebra increase logarithmically in both transverse and sagittal diameters, and linearly in both CSA and volume. The age-specific reference intervals for evolving T6 vertebra present the normative values of potential relevance in the diagnosis of congenital spinal defects.
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Affiliation(s)
- Michał Szpinda
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, Karłowicza 24 Street, 85-092, Bydgoszcz, Poland,
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Cross-sectional study of the neural ossification centers of vertebrae C1-S5 in the human fetus. Surg Radiol Anat 2013; 35:701-11. [PMID: 23455365 PMCID: PMC3784062 DOI: 10.1007/s00276-013-1093-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 02/15/2013] [Indexed: 12/17/2022]
Abstract
Purpose An understanding of the normal evolution of the spine is of great relevance in the prenatal detection of spinal abnormalities. This study was carried out to estimate the length, width, cross-sectional area and volume of the neural ossification centers of vertebrae C1–S5 in the human fetus. Materials and methods Using the methods of CT (Biograph mCT), digital-image analysis (Osirix 3.9) and statistics (the one-way ANOVA test for paired data, the Kolmogorov–Smirnov test, Levene’s test, Student’s t test, the one-way ANOVA test for unpaired data with post hoc RIR Tukey comparisons) the size for the neural ossification centers throughout the spine in 55 spontaneously aborted human fetuses (27 males, 28 females) at ages of 17–30 weeks was studied. Results The neural ossification centers were visualized in the whole pre-sacral spine, in 74.5 % for S1, in 61.8 % for S2, in 52.7 % for S3, and in 12.7 % for S4. Neither male–female nor right–left significant differences in the size of neural ossification centers were found. The neural ossification centers were the longest within the cervical spine. The maximum values referred to the axis on the right, and to C5 vertebra on the left. There was a gradual decrease in length for the neural ossification centers of T1–S4 vertebrae. The neural ossification centers were the widest within the proximal thoracic spine and narrowed bi-directionally. The growth dynamics for CSA of neural ossification centers were found to parallel that of volume. The largest CSAs and volumes of neural ossification centers were found in the C3 vertebra, and decreased in the distal direction. Conclusions The neural ossification centers show neither male–female nor right–left differences. The neural ossification centers are characterized by the maximum length for C2–C6 vertebrae, the maximum width for the proximal thoracic spine, and both the maximum cross-sectional area and volume for C3 vertebra. There is a sharp decrease in size of the neural ossification centers along the sacral spine. A decreasing sequence of values for neural ossification centers along the spine from cervical to sacral appears to parallel the same direction of the timing of ossification. The quantitative growth of the neural ossification centers is of potential relevance in the prenatal diagnosis and monitoring of achondrogenesis, caudal regression syndrome, diastematomyelia and spina bifida.
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Szpinda M, Baumgart M, Szpinda A, Woźniak A, Małkowski B, Wiśniewski M, Mila-Kierzenkowska C, Króliczewski D. Cross-sectional study of the ossification center of the C1-S5 vertebral bodies. Surg Radiol Anat 2012. [PMID: 23192240 PMCID: PMC3689470 DOI: 10.1007/s00276-012-1045-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose Knowledge on the normative growth of the spine is relevant in the prenatal detection of its abnormalities. This study describes the size of the ossification center of C1–S5 vertebral bodies. Materials and methods Using CT, digital-image analysis, and statistics, the size of the ossification center of C1–S5 vertebral bodies in 55 spontaneously aborted human fetuses aged 17–30 weeks was examined. Results No sex significant differences were found. The body ossification centers were found within the entire presacral spine and in 85.5 % of S1, in 76.4 % of S2, in 67.3 % of S3, in 40.0 % of S4, and in 14.5 % of S5. All the values for the atlas were sharply smaller than for the axis. The mean transverse diameter of the body ossification center gradually increased from the axis to T12 vertebra, so as to stabilize through L1–L3 vertebrae, and finally was intensively decreasing to S5 vertebra. There was a gradual increase in sagittal diameter of the body ossification center from the axis to T5 vertebra and its stabilization for T6–T9 vertebrae. Afterward, an alternate progression was observed: a decrease in values for T10–T12 vertebrae, an increase in values for L1–L2 vertebrae, and finally a decrease in values for L3–S5 vertebrae. The values of cross-sectional area of ossification centers were gradually increasing from the axis to L2 vertebra and then started decreasing to S5 vertebra. The following cross-sectional areas were approximately equivalent to each other: for L5 and T3–T5, and for S4 and C1. The volumetric growth of the body ossification center gradually increased from the axis to L3 vertebra and then sharply decreased from L4 to S5. Conclusions No male–female differences are found in the size of the body ossification centers of the spine. The growth dynamics for morphometric parameters of the body ossification centers of the spine follow similarly with gestational age.
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Affiliation(s)
- Michał Szpinda
- Department of Normal Anatomy, The Nicolaus Copernicus University in Toruń, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, Karłowicza 24 Street, 85-092, Bydgoszcz, Poland.
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Baumgart M, Szpinda M, Szpinda A. New anatomical data on the growing C4 vertebra and its three ossification centers in human fetuses. Surg Radiol Anat 2012; 35:191-203. [PMID: 22986651 PMCID: PMC3604597 DOI: 10.1007/s00276-012-1022-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 09/04/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Detailed knowledge on the normative growth of the spine is of great relevance in the prenatal diagnosis of its abnormalities. The present study was conducted to compile age-specific reference data for vertebra C4 and its three ossification centers in human fetuses. MATERIALS AND METHODS With the use of CT (Biograph mCT), digital image analysis (Osirix 3.9) and statistical analysis (Wilcoxon signed-rank test, Kolmogorov-Smirnov test, Levene's test, Student's t test, one-way ANOVA, post hoc RIR Tukey test, linear and nonlinear regression analysis), the normative growth of vertebra C4 and its three ossification centers in 55 spontaneously aborted human fetuses (27 males, 28 females) aged 17-30 weeks was examined. RESULTS Significant differences in neither sex nor laterality were found. The height and transverse and sagittal diameters of the C4 vertebral body increased logarithmically as: y = -3.866 + 2.225 × ln(Age) ± 0.238 (R(2) = 0.69), y = -7.077 + 3.547 × ln(Age) ± 0.356 (R(2) = 0.72) and y = -3.886 + 2.272 × ln(Age) ± 0.222 (R(2) = 0.73), respectively. The C4 vertebral body grew linearly in cross-sectional area as y = -7.205 + 0.812 × Age ± 1.668 (R(2) = 0.76) and four-degree polynomially in volume as y = 14.108 + 0.00007 × Age(4) ± 6.289 (R(2) = 0.83). The transverse and sagittal diameters, cross-sectional area and volume of the ossification center of the C4 vertebral body generated the following functions: y = -8.836 + 3.708 × ln(Age) ± 0.334 (R(2) = 0.76), y = -7.748 + 3.240 × ln(Age) ± 0.237 (R(2) = 0.83), y = -4.690 + 0.437 × Age ± 1.172 (R(2) = 0.63) and y = -5.917 + 0.582 × Age ± 1.157 (R(2) = 0.77), respectively. The ossification center-to-vertebral body volume ratio gradually declined with age. On the right and left, the neural ossification centers showed the following growth: y = -19.601 + 8.018 × ln(Age) ± 0.369 (R(2) = 0.92) and y = -15.804 + 6.912 × ln(Age) ± 0.471 (R (2) = 0.85) for length, y = -5.806 + 2.587 × ln(Age) ± 0.146 (R(2) = 0.88) and y = -5.621 + 2.519 × ln(Age) ± 0.146 (R(2) = 0.88) for width, y = -9.188 + 0.856 × Age ± 2.174 (R(2) = 0.67) and y = -7.570 + 0.768 × Age ± 2.200 (R(2) = 0.60) for cross-sectional area, and y = -13.802 + 1.222 × Age ± 1.872 (R(2) = 0.84) and y = -11.038 + 1.061 × Age ± 1.964 (R(2) = 0.80) for volume, respectively. CONCLUSIONS The morphometric parameters of vertebra C4 and its three ossification centers show no sex differences. The C4 vertebral body increases logarithmically in height and both sagittal and transverse diameters, linearly in cross-sectional area, and four-degree polynomially in volume. The three ossification centers of vertebra C4 grow logarithmically in both transverse and sagittal diameters, and linearly in both cross-sectional area and volume. The age-specific reference intervals for evolving vertebra C4 may be useful in the prenatal diagnosis of congenital spinal defects.
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Affiliation(s)
- Mariusz Baumgart
- Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University in Toruń, Karłowicza 24 Street, 85-092, Bydgoszcz, Poland
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