Hemivertebra is the most common cause of the congenital spinal deformity and many patients also manifest deformities in other systems. Beauregard-Lacroix [13]. conducted a retrospective study from 2004 to 2015 in 300 congenital spinal deformity patients and found up to 67.1% of them had associated anomalies of different systems. This is one of the important reasons why it is difficult to make decisions whether keeping the fetus with HV in China.
The etiology of congenital spinal deformity is considered to be multifactorial, containing both genetic and environmental factors. The genetic factors remain much unknown and some studies found it a multi genetic disease. Studies also demonstrated that environmental aspects played an important role in the development of congenital spinal deformity involving vitamin deficiency, hypoxia, alcohol use, exposure to hyperthermia, boric acid, and valproic acid [5,16-19].
About the natural history of congenital spinal deformity, 25% of the curves do not progress, 25% progress slowly and 50% progress rapidly [14]. And fully segmented HV has the highest potential for progression [15]. The rate of deterioration and the severity of the spinal deformity depends on the number, type, and site of HV.
Involving the treatment, many studies with long term follow-up concluded that early HV resection was a safe and effective way to correct the spinal deformity and restore the spinal balance [2,20-25]. But there are also long-time follow-up studies found that spinal deformity secondary to HV could be treated conservatively and some patients even had gradual improvement without treatment [26-27].
This is the only multi-dimensional and well-attended online survey on this topic. In our survey, among the medical groups, most of the ultrasonologists (81.48%) suggested the parents see a spine surgeon and obstetrician for advice. And most of the obstetricians (89.71%) suggested the pregnant women do further examinations to exclude accompanied abnormalities and consult the spine surgeons/orthopedic surgeons for suggestions. Among the non-medical related groups, most of them also chose the consult the spine surgeons and obstetricians. So finally the spine surgeons and orthopedic surgeons need to make the final suggestion, and most of them recommended keeping the baby or explain the pros and cons to the parents. As professional doctors treating spinal deformity, most spine surgeons/orthopedic surgeons understand the causes and treatment of this condition, basically support to keep the baby and will communicate with the patient to explain the situation in detail.
Moreover, 62.86% of the surveyed obstetricians never met a fetus with HV at work, 40.29% of obstetricians don’t even know that HV could result in spinal deformity. They paid more attention to observe whether the fetus had other abnormalities. That is also why 89.71% of them suggested the parents do further examinations and see a spine surgeon/orthopedic surgeon. Therefore, it is also necessary for obstetricians to understand the impact of spinal abnormalities on the child's future as an important part of fetal development. Also, the multi-professional cooperation consultation will help to make the best decision
Also as an important part of fetal development, although 68.52% of the ultrasound doctors never met a fetus with HV at work, 85.19% of them know the harm of the hemivertebra. And if the examination found that the fetus has a hemivertebra, the pregnant women will be recommended to the department of obstetrics and spine/orthopedics for further consultation.
For scoliosis patients, there is still a large amount of concern about spinal deformity caused by hemivertebra, other study indicated that the scoliosis patient had an increased incidence and risk of depression [28]. so maybe this is why up to 26.83% of the scoliosis patients chose to terminate the pregnancy. They also wanted to understand the causes, prevention methods, treatment of spinal deformity, and the children's future.
As the largest group (4062/5586, 72.72%) participating in the questionnaire, there are up to 76.17% of the general public who have little or don’t have any knowledge of spinal deformity. That is why 14.28% chose to terminate the pregnancy, and thus more of them wanted to know the causes, prevention methods, treatment of spinal deformity, and the children's future. Furthermore, the general public with or without a child had almost the same choices about the fetus and what they wanted to know most about congenital spinal deformity. With the advancement of educational background, the percentage of those knowing spinal deformity is increasing, and more chose to keep the baby, more wanted to know the treatment and future of their children (Tables 1, 2, and 3).