Ten-year clinical and imaging follow-up of dural ectasia in adults with Marfan syndrome

Department of Orthopaedic Surgery, The Johns Hopkins University, 601 N. Caroline St, Baltimore, MD 21287, USA.
The spine journal: official journal of the North American Spine Society (Impact Factor: 2.9). 12/2012; 13(1). DOI: 10.1016/j.spinee.2012.10.021
Source: PubMed

ABSTRACT BACKGROUND CONTEXT: 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. PURPOSE: 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. STUDY DESIGN: Prospective cohort study. PATIENT SAMPLE: 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. OUTCOME MEASURES: The ODI, MRI-based qualitative and quantitative measurements, CT-based quantitative measurements. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

  • Indian journal of anaesthesia 01/2013; 57(6):624-625. DOI:10.4103/0019-5049.123344
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Marfan syndrome (MFS) is a genetic disorder of the connective tissue. Aortic root dilation is a main criterion of the Ghent Nosology. Dural ectasia and the presence of mitral valve prolapse (MVP) contribute to its systemic score. The purpose of this study was to investigate the frequency of dural ectasia and its correlation with cardiovascular manifestations in a pediatric study population.Patients and methods: 119 pediatric patients with confirmed or suspected MFS were examined in the local Marfan Clinic. 31 children with MFS who underwent magnetic resonance imaging (MRI) were included. Each patient was evaluated according to the Ghent nosology. Echocardiography was used to measure the aortic root diameter and assess the presence of MVP and mitral regurgitation. Z-scores were calculated for the evaluation of the aortic root diameters. MRI was performed to determine the dural sac ratio (DSR).Results: The prevalence of dural ectasia was 90.3 %, of aortic root dilation 32.2 %, of MVP 64.5 % and of mitral regurgitation 51.6 %. DSR at L5 correlated with the intraindividual z-scores (slope, 3.62 ± 1.5 [0.56; 6.68]; r = 0.17; p = 0.02; F = 5.84). Z-scores ≥ 2 were accompanied by dural ectasia in 100 %, MVP in 95 % and mitral regurgitation in 100 % of cases. MVP was accompanied by mitral regurgitation in 70 % of cases.Conclusion: As the examined cardiac manifestations show a coincidence with dural ectasia in 95 - 100 % of cases, MRI for diagnostic dural sac imaging should be reserved for MFS suspicions with the absence of those manifestations in order to establish the diagnosis according to the Ghent criteria. Thus, the present study supports the recent downgrading of dural ectasia to a contributor to the systemic score.Citation Format:
    RöFo - Fortschritte auf dem Gebiet der R 09/2013; 186(1). DOI:10.1055/s-0033-1350421 · 2.76 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to assess the frequency, severity, and clinical associations of dural ectasia (DE) in Loeys-Dietz syndrome (LDS). Database analysis of three German metropolitan regions identified 30 patients with LDS and TGFBR1 mutation in 6 and a TGFBR2 mutation in 24 individuals (17 men; mean age: 31 ± 19 years), as well as 60 age and sex-matched control patients with Marfan syndrome carrying a FBN1 mutation. DE was present in 22 patients with LDS (73%), and it related to skeletal score points (p = 0.008), non-skeletal score points (p < 0.001), and to the presence of ≥7 systemic score points (p = 0.010). Similarly, the severity of DE was related to body height (p = 0.010) and non-skeletal score points (p = 0.004). Frequency (p = 0.131) and severity of DE (p = 0.567) was similar in LDS and Marfan syndrome. DE is a manifestation of LDS that occurs with similar frequency and severity as in Marfan syndrome. Severity of DE may serve as a marker of the overall connective tissue disease severity. LDS may be considered in patients with DE.
    Clinical Genetics 10/2013; DOI:10.1111/cge.12308 · 3.65 Impact Factor