Cha Myung-Jin, ElNemer William, Sponseller Paul D
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD.
J Pediatr Orthop. 2025 Aug 1;45(7):445-450. doi: 10.1097/BPO.0000000000002968. Epub 2025 Apr 24.
Understanding vertebral anatomy is crucial for the secure fixation of spinal instrumentation. Using MRI and CT scans can identify safe locations for pedicle screw insertion and/or discover underlying pathologies such as dural ectasia. In this study, we explored Marfan vertebrae morphology and compared it to that of idiopathic scoliotic vertebrae. We investigated whether the pedicles and laminae of patients with Marfan syndrome (1) would differ from those with idiopathic scoliosis (IS) and (2) would be affected by the position in the curve and by dural ectasia.
Using MRI and CT scans, the morphologies of 134 vertebrae from T1 to L5 were measured in 16 Marfan patients with spine deformity. The morphologies of 140 vertebrae in 20 patients with IS were measured in the same fashion. They were then compared with each other.
Marfan pedicle channels were significantly thinner than those with idiopathic scoliosis ( P <0.001). This difference increased significantly from cranial to caudal. Type D pedicles (<2 mm wide) were found in 34% of Marfan and 9% of IS patients ( P <0.001). Marfan type D pedicles were found in 36% of atypical locations (outside the concave apex). Pedicle width significantly correlated with both vertebral level and distance from the apex. Pedicles became progressively thinner than IS pedicles at descending levels of the spine. Pedicle width and laminar thickness measurements on CT and MRI did not differ significantly. The average thickness of the Marfan lamina was significantly thinner (by a mean of 1 mm) than that of the IS lamina ( P <0.001). Marfan patients with dural ectasia had significantly thinner laminae in the lumbar spine than those without ( P =0.023).
Marfan spines were associated with thinning of fixation sites, most pronounced at the curve apex. Laminar thinning was more common on the concavity and with dural ectasia. Radiographs often overestimate the width. Therefore, preoperative MRI or CT is helpful when operating on Marfan spine with pedicle screws and laminar hooks.
Level III-retrospective cohort study.
了解椎体解剖结构对于脊柱内固定器械的安全固定至关重要。利用磁共振成像（MRI）和计算机断层扫描（CT）可以确定椎弓根螺钉置入的安全位置和/或发现潜在病变，如硬脊膜扩张。在本研究中，我们探讨了马方综合征患者椎体的形态，并将其与特发性脊柱侧凸患者的椎体形态进行比较。我们研究了马方综合征患者的椎弓根和椎板是否（1）与特发性脊柱侧凸患者不同，以及（2）是否会受到脊柱侧凸部位和硬脊膜扩张的影响。
利用MRI和CT扫描，对16例患有脊柱畸形的马方综合征患者的134个从T1至L5的椎体形态进行测量。以同样的方式测量了20例特发性脊柱侧凸患者的140个椎体形态。然后将两者进行相互比较。
马方综合征患者的椎弓根通道明显比特发性脊柱侧凸患者的窄（P<0.001）。这种差异从颅侧到尾侧显著增加。在34%的马方综合征患者和9%的特发性脊柱侧凸患者中发现了D型椎弓根（宽度<2mm）（P<0.001）。在36%的非典型位置（凹侧顶点以外）发现了马方综合征患者的D型椎弓根。椎弓根宽度与椎体节段和距顶点的距离均显著相关。在脊柱向下的节段，马方综合征患者的椎弓根比特发性脊柱侧凸患者逐渐变窄。CT和MRI上的椎弓根宽度和椎板厚度测量结果无显著差异。马方综合征患者的椎板平均厚度比特发性脊柱侧凸患者薄（平均薄1mm）（P<0.001）。有硬脊膜扩张的马方综合征患者腰椎的椎板比没有硬脊膜扩张的患者明显更薄（P=0.023）。
马方综合征患者的脊柱与固定部位变薄有关，在侧凸顶点最为明显。椎板变薄在凹侧和硬脊膜扩张时更常见。X线片常高估椎弓根宽度。因此，在对马方综合征患者的脊柱进行椎弓根螺钉和椎板钩手术时，术前MRI或CT检查很有帮助。
Ⅲ级——回顾性队列研究。
