Acta Neurochirurgica

, Volume 160, Issue 8, pp 1613–1619 | Cite as

Cluster analysis describes constellations of cardiac anomalies presenting in spinal anomaly patients

  • Peter G. PassiasEmail author
  • Gregory W. Poorman
  • Dennis Vasquez-Montes
  • Charles Wang
  • Cyrus Jalai
  • Samantha R. Horn
  • Leah M. Steinmetz
  • Cole A. Bortz
  • Frank A. Segreto
  • John Moon
  • Peter L. Zhou
  • Bassel G. Diebo
  • Shaleen Vira
Original Article - Spine - Other
Part of the following topical collections:
  1. Spine - Other



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.


Kids’ Inpatient Database (KID) VACTERL Congenital scoliosis Spine deformity Surgical correction Cardiac anomaly 



Adult spine deformity


Healthcare Cost and Utilization Project


International Classification of Disease, Ninth Revision, Clinical Modification


Institutional review board


Kids’ Inpatient Database


Patent ductus arteriosus


Vertebral anomalies, anal atresia, cardiac malformations, trachea-esophageal fistula, renal dysplasia, and limb anomalies


Compliance with ethical standards

Conflict of interest

Dr. Passias reports personal fees from Medicrea, personal fees from SpineWave, non-financial support from Allosource, personal fees from Zimmer Biomet, personal fees from Globus, grants from CSRS, personal fees from Aesculap, outside the submitted work. All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical review committee statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Peter G. Passias
    • 1
    Email author
  • Gregory W. Poorman
    • 1
  • Dennis Vasquez-Montes
    • 1
  • Charles Wang
    • 1
  • Cyrus Jalai
    • 1
  • Samantha R. Horn
    • 1
  • Leah M. Steinmetz
    • 1
  • Cole A. Bortz
    • 1
  • Frank A. Segreto
    • 1
  • John Moon
    • 1
  • Peter L. Zhou
    • 1
  • Bassel G. Diebo
    • 2
  • Shaleen Vira
    • 1
  1. 1.Division of Spinal Surgery, Departments of Orthopaedic and Neurological Surgery, NY Spine Institute, New York University Medical CenterNYU Langone Orthopedic HospitalNew YorkUSA
  2. 2.Department of Orthopaedic SurgerySUNY Downstate Medical CenterBrooklynUSA

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