=====Hemivertebra====== Hemivertebra is a type of vertebral anomaly and results from a lack of formation of one half of a vertebral body. Hemivertebra, associated with a failure in the formation and fusion of vertebral body ossification nuclei, are a common cause of thoracic or lumbar scoliosis. 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. Pathology It falls under the spectrum of segmentational anomalies and can involve one or multiple levels. A hemivertebra acts as a wedge within the vertebral column, resulting in curvature away from the side on which it is present. Associations Recognised associations are many and include: Aicardi syndrome cleidocranial dysostosis gastroschisis 3 Gorlin syndrome fetal pyelectasis 3 [[Jarcho Levin syndrome]] OEIS complex [[VACTERL]] association mucopolysaccharidosis 9 This list supposed to be lot longer than this. If you know more, do add in with a relevant journal reference. Classification A hemivertebra can be classified according to many types which include: Attachment fully segmental (free) not attached to either vertebra above or below most concerning semi segmental: half segment is fused with vertebra above or below with no intervening intervertebral disc non segemental not seperated from (i.e. connected to) either level above or below causes less of a concern incarcerated joined by pedicles to levels above and below causes less of a concern Orientation dorsal hemivertebra: classically results in a kyphosis lateral hemivertebra: classically results in a scoliosis ventral hemivertebra (extremely rare): results in the lordosis Radiographic features Antenatal ultrasound A hemivertebra may be seen as an asymmetrical vertebral body on sagittal or coronal scanning, while on axial scanning, a focal defect may be seen at either side of the vertebral column 5. Plain film/CT Usually directly outlines the bony anomaly and often seen as a wedge shaped vertebral body. 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. Differential diagnosis For antenatal sonographic appearances consider: [[Block vertebra]]