Osseous anatomy of the lumbosacral spine in Marfan syndrome

Study Design. This study examines pedicle widths, laminar thicknesses, and scalloping values for lumbosacral spine elements in Marfan volunteers. Comp arisons were made between these measurements and norms as well as measureme nts between Marfan patients with and without dural ectasia. Objectives. To determine if the lumbosacral vertebral elements are altered in the patient with Marfan syndrome, Summary of Background Data. Several abnormalities have been noted in Marfan lumbar spine, including pedicular attenuation and widened interpediculate distances. This may be due to abnormalities of growth or presence of dural ectasia. Given the large numbers of Marfan patients requiring spinal surger y and the high postoperative failure rate, better understanding of the bony anatomy of Marfan lumbar spine is necessary, especially if use of instrume ntation is anticipated. Methods, Thirty-two volunteers with Marfan syndrome based on the Ghent crit eria underwent spiral computed tomography of the lumbosacral spine, images were evaluated for dural ectasia, and measurements of pedicle width, lamina r thickness, and vertebral scalloping were made. Results. Pedicle widths and laminar thicknesses were significantly smaller in Marfan patients at all levels (P < 0.001), Mean pedicle widths at L1-L3 were smaller than the smallest available pedicle screw (5 mm). In Marfan pa tients with dural ectasia, laminar thickness from L5-S2 and pedicle widths at all lumbar levels were significantly reduced (P < 0.01). Vertebral scall oping at S1 was significantly greater in Marfan patients with dural ectasia (P = 0.02). Conclusion. Lumbar pedicle width and laminar thick:ness are significantly r educed in Marfan individuals, Those with dural ectasia demonstrate increase d bony erosion of anterior and posterior elements of lumbosacral spine. Pre operative planning and routine computed tomography scans are recommended wh en operating on Marfan lumbosacral spine.