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.
Similar content being viewed by others
Data availability
All patient identifier information was removed from radiographs prior to analysis. This includes both electronic and physical radiographs.
References
Dietz H, Cutting GR, Pyeritz RE et al (1991) Marfan syndrome caused by a recurrent de novo missense mutation in the fibrillin gene. Nature 352:337–339
Kainulainen K, Karttunen L, Puhakka L et al (1994) Mutations in the fibrillin gene responsible for dominant ectopia lentis and neonatal Marfan syndrome. Nat Genet 6(1):64–69
Erkula G, Jones KB, Sponseller PD et al (2002) Growth and maturation in Marfan syndrome. Am J Med Genet 109:100–115
Sponseller PD, Hobbs W, Riley LH 3rd et al (1995) The thoracolumbar spine in Marfan syndrome. J Bone Joint Surg (American) 77(6):867–876
Robbins PR, Moe JH, Winter RB (1975) Scoliosis in Marfan’s syndrome: its characteristics and results of treatment in thirty-five patients. J Bone Joint Surg 57:358–368
Tallroth K, Malmivaara A, Laitinen ML et al (1995) Lumbar spine in Marfan syndrome. Skeletal Radiol 24:337–340
Demetracopoulos CA, Sponseller PD (2007) Spinal deformities in Marfan syndrome. Orthop Clin North Am 38(4):563–572
Glard Y, Pomero V, Collignon P et al (2008) Sagittal balance in scoliosis associated with Marfan syndrome: a stereoradiographic three-dimensional analysis. J Child Orthop 2(2):113–118
Spiegel DA, Flynn JM, Stasikelis PJ et al (2003) Scoliotic curve patterns in patients with Chiari I malformation and/or syringomyelia. Spine J (American) 28(18):2139–2146
Loubresse CG, Mullins M, Moura B et al (2006) Spinal and pelvic parameters in Marfan’s syndrome and their relevance to surgical planning. J Bone Joint Surg 88(4):515–519
Labelle H, Roussly P, Berthonnaud E et al (2005) The importance of spino-pelvic balance in L5–S1 developmental spondylolysthesis: a review of pertinent radiologic measurements. Spine 30(6):27–34
Jentzsch T, Geiger J, Bouaicha S et al (2013) Increased pelvic incidence may lead to arthritis and sagittal orientation of the facet joints at the lower lumbar spine. BMC Med Imaging 5(13):34
Vrtovec T, Janssen MM, Pernuš F et al (2012) Analysis of pelvic incidence from 3-dimensional images of a normal population. North Am Spine J 37(8):479–485
Legaye J, Duval-Beaupère G, Hecquet J et al (1998) Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 7:99–103
Funding
This study did not require funding.
Author information
Authors and Affiliations
Contributions
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.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest.
Ethical approval
This is a retrospective radiological study. Ethical approval was not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43390-022-00484-x