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Evaluating the sagittal spinal and pelvic parameters in Marfan syndrome patients affected by scoliosis

Abstract

Introduction

Spinal deformities present a common finding in patients affected with Marfan syndrome (MFS). More specifically, sagittal spine imbalances reflect the typical finding of such deformities. Observing spino-pelvic radiographs, we focused on eliciting any correlation between the pelvic incidence (PI), sacral slope (SS) and thoracolumbar kyphosis measurements, and categorising them according to a sagittal spinal classification system.

Materials and methods

One hundred seventy patient records were found over a 6 year period, and further refined to incorporate a total of 44 patients. 25 males and 19 females with an average age of 20 years at imaging. Electronic and hard copies of radiographs were used and measurements were made with virtual Cobb meters, rulers and protractors.

Results

The mean PI was significantly different between type-I (46°) and type-II spines (35°) (p = 0.04), and the values for each class were as follows: type IA—53°, type IB—44°, type IC—36°, type IIA—42°, and type IIB—34°. Type II spines had a lower PI compared to type IA spines (p = 0.037) and to that of an unaffected population. Statistically significant differences were noted in SS between groups (t test; p < 0.001), and ANOVA demonstrated that the largest differences between spinal classes were found in SS.

Conclusion

In our study, PI values were much higher in type I compared to type II spines. Type II spines had PI values as expected, however, had higher than expected SS values. SS followed a down trending pattern across all spinal classes. Type IIA spines had a much greater preponderance for male patients. Overall, we wish to highlight in particular that type II spines were associated with a much lower PI and SS, and report these differences in pelvic morphology and sagittal spine patterns seen in MFS patients. The pelvic tilt and sacral slope parameters observed in our Type II spines may further reflect and characterize the deformity.

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Data availability

All patient identifier information was removed from radiographs prior to analysis. This includes both electronic and physical radiographs.

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Funding

This study did not require funding.

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SJS—made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work;—drafted the work or revised it critically for important intellectual content;—approved the version to be published; and—agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AM—made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work;—drafted the work or revised it critically for important intellectual content;—approved the version to be published; and—agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. PDS—made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work;—drafted the work or revised it critically for important intellectual content;—approved the version to be published; and—agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Sukrit Jushay Suresh.

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The authors declare that they have no conflicts of interest.

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This is a retrospective radiological study. Ethical approval was not required.

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Suresh, S.J., Margalit, A. & Sponseller, P.D. Evaluating the sagittal spinal and pelvic parameters in Marfan syndrome patients affected by scoliosis. Spine Deform 10, 873–881 (2022). https://doi.org/10.1007/s43390-022-00484-x

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Keywords

  • Marfan syndrome
  • Scoliosis
  • Pelvic incidence
  • Pelvic tilt
  • Sacral slope