Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NY Spine Institute, New York University Medical Center, NYU Langone Orthopedic Hospital, 301 East 17th Street, New York, NY, 10003, USA.
Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, 11203, USA.
Acta Neurochir (Wien). 2018 Aug;160(8):1613-1619. doi: 10.1007/s00701-018-3596-7. Epub 2018 Jun 28.
Cardiac anomalies are prevalent in patients with bony spinal anomalies. Prior studies evaluating incidences of bony congenital anomalies of the spine are limited. The Kids' Inpatient Database (KID) yields national discharge estimates of rare pediatric conditions like congenital disorders. This study utilized cluster analysis to study patterns of concurrent vertebral anomalies, anal atresia, cardiac malformations, trachea-esophageal fistula, renal dysplasia, and limb anomalies (VACTERL anomalies) co-occurring in patients with spinal congenital anomalies.
Retrospective review of KID 2003-2012. KID-supplied hospital- and year-adjusted weights allowed for incidence assessment of bony spinal anomalies and cardiac, gastrointestinal, urinary anomalies of VACTERL. K-means clustering assessed relationships between most frequent anomalies within bony spinal anomaly discharges; k set to n - 1(n = first incidence of significant drop/little gain in sum of square errors within clusters).
There were 12,039,432 KID patients 0-20 years. Incidence per 100,000 discharges: 2.5 congenital fusion of spine, 10.4 hemivertebra, 7.0 missing vertebra. The most common anomalies co-occurring with bony vertebral malformations were atrial septal defect (ASD 12.3%), large intestinal atresia (LIA 11.8%), and patent ductus arteriosus (PDA 10.4%). Top congenital cardiac anomalies in vertebral anomaly patients were ASD, PDA, and ventricular septal defect (VSD); all three anomalies co-occur at 6.6% rate in this vertebral anomaly population. Cluster analysis revealed that of bony anomaly discharges, 55.9% of those with PDA had ASD, 34.2% with VSD had PDA, 22.9% with LIA had ASD, 37.2% with ureter obstruction had LIA, and 35.5% with renal dysplasia had LIA.
In vertebral anomaly patients, the most common co-occurring congenital anomalies were cardiac, renal, and gastrointestinal. Top congenital cardiac anomalies in vertebral anomaly patients were ASD, PDA, and VSD. VACTERL patients with vertebral anomalies commonly presented alongside cardiac and renal anomalies.
心脏异常在患有骨脊柱异常的患者中很常见。先前评估脊柱先天性异常发生率的研究仅限于骨畸形。儿童住院数据库（KID）提供了全国罕见儿科疾病（如先天性疾病）的出院估计数。本研究利用聚类分析研究了脊柱先天性异常患者并发椎体异常、肛门闭锁、心脏畸形、气管食管瘘、肾发育不良和肢体异常（VACTERL 异常）的模式。
回顾性审查 KID 2003-2012 年。KID 提供的医院和年份调整权重允许评估骨脊柱异常和心脏、胃肠道、泌尿系统 VACTERL 畸形的发生率。K-均值聚类评估了骨脊柱异常放电中最常见异常之间的关系；k 设置为 n-1（n=聚类中平方和误差显著下降/小幅度增加的第一次发生率）。
KID 患者 0-20 岁有 12039432 人。每 100000 次出院的发生率：2.5 例脊柱先天性融合，10.4 例半椎体，7.0 例椎体缺失。与骨椎畸形最常见的并发异常是房间隔缺损（ASD 12.3%）、大肠闭锁（LIA 11.8%）和动脉导管未闭（PDA 10.4%）。在椎体异常患者中，先天性心脏异常的主要是 ASD、PDA 和室间隔缺损（VSD）；这三种异常在该椎体异常人群中的发生率为 6.6%。聚类分析显示，在骨畸形放电中，55.9%的 PDA 患者有 ASD，34.2%的 VSD 患者有 PDA，22.9%的 LIA 患者有 ASD，37.2%的输尿管梗阻患者有 LIA，35.5%的肾发育不良患者有 LIA。
在椎体异常患者中，最常见的并发先天性异常是心脏、肾脏和胃肠道。椎体异常患者中先天性心脏异常的主要是 ASD、PDA 和 VSD。伴有椎体异常的 VACTERL 患者常伴有心脏和肾脏异常。
