Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline St, Baltimore, MD 21287, USA.
Spine J. 2013 Jan;13(1):62-7. doi: 10.1016/j.spinee.2012.10.021. Epub 2012 Dec 6.
Dural ectasia in the lumbosacral spine is a common feature of Marfan syndrome and is associated with low back pain and surgical complications, but its natural history is unknown.
To evaluate the natural history of dural ectasia in adults with Marfan syndrome by determining if, over time, symptoms associated with dural ectasia worsen, dural ectasia imaging findings worsen, or spondylolisthesis/spondylolysis develops or worsens.
Prospective cohort study.
For our prospective follow-up study, we enrolled 20 patients with Marfan syndrome and dural ectasia who, from 1998 through 1999, had undergone magnetic resonance imaging (MRI) and computed tomography (CT) of the lumbosacral spine and had completed the Oswestry Disability Index (ODI) questionnaire. Of the 20, five did not meet the inclusion criterion of a completed 2009 ODI questionnaire and were excluded. The remaining 15 patients (mean age, 49.6 years; mean follow-up, 10.5 years) formed our study group.
The ODI, MRI-based qualitative and quantitative measurements, CT-based quantitative measurements.
We performed matched-pair analyses via Student t test and Wilcoxon signed-rank test of the ODI scores (15 pairs), dural volume of L5-S2 (eight pairs), dural sac ratio (DSR) of L4-S2 (nine pairs), development/progression of spondolysthesis/spondylolysis (11 pairs), and Fattori qualitative grading of dural ectasia size (10 pairs). Significance was set at p<.05.
We found no statistical differences in the 1998/1999 and 2009 ODI scores (25.8 vs. 22.2 points), dural volume (70.4 vs. 73.9 cm(3)), or DSR (0.68, 0.78, 2.04, and 58.1 vs. 0.69, 0.83, 2.30, and 70.20). There was also no development or progression of spondylolisthesis/spondylolysis and no increase in dural ectasia size.
During this 10-year period, the natural history of dural ectasia in adults with Marfan syndrome was not associated with a significant increase in ODI scores, dural ectasia size, or with the development/progression of spondylolisthesis or spondylolysis.
腰骶部硬脊膜膨出是马凡综合征的一个常见特征，与腰痛和手术并发症有关，但它的自然病史尚不清楚。
通过确定与硬脊膜膨出相关的症状是否随时间恶化、硬脊膜膨出的影像学表现是否恶化、或脊椎滑脱/脊椎裂是否发展或恶化，来评估马凡综合征成人硬脊膜膨出的自然病史。
前瞻性队列研究。
在我们的前瞻性随访研究中，我们招募了 20 名患有马凡综合征和硬脊膜膨出的患者，他们在 1998 年至 1999 年期间接受了腰骶部磁共振成像（MRI）和计算机断层扫描（CT）检查，并完成了 Oswestry 残疾指数（ODI）问卷。其中 20 名患者中有 5 名不符合完成 2009 年 ODI 问卷的纳入标准而被排除。其余 15 名患者（平均年龄 49.6 岁；平均随访时间 10.5 年）构成了我们的研究组。
ODI、基于 MRI 的定性和定量测量、基于 CT 的定量测量。
我们通过学生 t 检验和 Wilcoxon 符号秩检验对 ODI 评分（15 对）、L5-S2 硬脊膜体积（8 对）、L4-S2 硬脊膜囊比（9 对）、脊椎滑脱/脊椎裂的发展/进展（11 对）和硬脊膜膨出大小的 Fattori 定性分级（10 对）进行了匹配对分析。显著性水平设定为 p<0.05。
我们发现 1998/1999 年和 2009 年 ODI 评分（25.8 与 22.2 分）、硬脊膜体积（70.4 与 73.9 cm³）或 DSR（0.68、0.78、2.04 和 58.1 与 0.69、0.83、2.30 和 70.20）均无统计学差异。脊椎滑脱/脊椎裂也没有发展或进展，硬脊膜膨出的大小也没有增加。
在这 10 年期间，马凡综合征成人硬脊膜膨出的自然病史与 ODI 评分、硬脊膜膨出大小或脊椎滑脱/脊椎裂的发展/进展无显著相关性。
