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Spinal dysraphism as a new entity in V.A.C.TE.R.L syndrome, resulting in a novel acronym V.A.C.TE.R.L.S


Anorectal malformation (ARM) is the most common symptom in VACTERL syndrome (vertebral, anal, cardiac, tracheo-esophageal fistula, renal, and limb anomalies). The association of ARM and spinal dysraphisms (DYS) is well documented. We aim to better evaluate children with VACTERL association and ARM, considering the presence or not of DYS. Between 2000 and 2015, 279 children with VACTERL associations were identified in Necker Children’s Hospital, Paris. We identified 61 VACTERL children (22%) with ARM. A total of 52 VACTERL children with ARM were included. DYS were identified in 36/52 of cases (69.2%). A total of 33 (63.5%) VACTERL children presented with sphincterial dysfunction. We constated that 28/33 (84.8%) of them had DYS + (p < 0.0001). More children in ARM (DYS +) subgroup are presenting with initial urinary sphincter dysfunction (58 vs 19%, p < 0.009) than ARM (DYS -). We identified 29 lipoma filum in our series, which were not statistically associated with urinary disorders (p = 0.143).

Conclusion: We propose to refine the definition of VACTERL association, by adding S as Spinal defect to include it as an integral part of this syndrome, resulting in a novel acronym V.A.C.TE.R.L.S.

What is Known:
• The VACTERL association: congenital anomalies of the bony vertebral column (V), anorectal malformation (A), congenital cardiopathy (C), tracheo-esophageal defects (TE), renal and urinary tract anomalies (R), and limb malformations (L).
• VACTERL children needs a complete appraisal, as early as possible, to adopt the most appropriate therapeutic management.
What is New:
• Include spine dysraphism (DYS) as a part of this syndrome, resulting in a novel acronym V.A.C.TE.R.L.S.
• The significant correlation between VACTERL/DYS and urinary dysfunction requires to investigate the spine cord prenatally.

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Fig. 1
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Anorectal malformation


Assisted reproductive techniques




In vitro fertilization


Magnetic resonance imaging


Vertebral (V), anorectal malformation (A), congenital cardiopathy (C), tracheo-esophageal defects (TE), renal and urinary tract anomalies (R), and limb malformations (L)


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We thank Pr Paul Chumas from Leeds for his proofreading of this study.

Author information

Aymeric Amelot: Dr. Amelot conceptualized and designed the study, carried out the initial analyses, drafted the initial manuscript, and approved the final manuscript as submitted.

Timothée de Saint Denis: Dr. de Saint Denis reviewed and revised the manuscript and approved the final manuscript as submitted.

Célia Cretolle: Dr. Cretolle coordinated and supervised data collection, critically reviewed the manuscript, and approved the final manuscript as submitted.

Sabine Sarnacki: Pr Sarnacki drafted the initial manuscript, reviewed the manuscript, and approved the final manuscript as submitted.

Martin Catala; Pr Catala drafted the initial manuscript, reviewed the manuscript, and approved the final manuscript as submitted.

Michel Zerah: Pr Zerah has operated and followed all the dysraphic patients and drafted the initial manuscript, reviewed the manuscript, and approved the final manuscript as submitted.

All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of the work.

Correspondence to Aymeric Amelot.

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Amelot, A., Cretolle, C., de Saint Denis, T. et al. Spinal dysraphism as a new entity in V.A.C.TE.R.L syndrome, resulting in a novel acronym V.A.C.TE.R.L.S. Eur J Pediatr (2020). https://doi.org/10.1007/s00431-020-03609-4

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  • VACTERL association
  • Anorectal malformation
  • Dysraphism
  • Spine
  • Lipoma
  • Urinary disorders