March20, 2023

Abstract Volume: 4 Issue: 6 ISSN:

Trible Curve Scoliosis with acetabula Protrusion in Marfan Syndrome

Shaker Abdulmajid Barker *

Corresponding Author: Shaker Abdulmajid Barker, Riadh Specialized Medical Centre, Jeddah, K.S.A.

Copy Right: © 2023 Shaker Abdulmajid Barker, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received Date: February 28, 2023

Published Date: March 15, 2023



Background: Marfan syndrome is an autosomal prevailing condition of connective tissue, and musculoskeletal system inclusions are the cardinal highlights. Triple rigid large major curve in conjunction with protrusion acetabula of the hip joints in Marfan syndrome is common then sagittal and coronal imbalance correction on this case is challenging.

Case Presentation: We detailed an instance of 15 years of age male with Marfan condition introduced triple rigid large Major curve scoliosis on left cervical-thoracic, right principal thoracic and left thoracolumbar, likewise protrusion acetabula to a greater degree toward the right side.

Conclusion: Detailed arranging scoliosis medical procedure is expected to address an uncommon the sagittal and coronal unevenness because of scoliosis confounded with protrusion acetabula of both hip joints in Marfan syndrome.

Key words: Marfan syndrome, Scoliosis, Protrusion acetabula.

Trible Curve Scoliosis with acetabula Protrusion in Marfan Syndrome


Marfan condition is an autosomal prevailing acquired connective tissue problem wherein the contribution of the visual, cardiovascular and musculoskeletal system is trademark. As numerous as 60% of patients with Marfan disorder have scoliosis, and no less than one-quarter to one-half of all patients have huge curves that require revision (1). Protrusion acetabula of hip joints might happen in Marfan syndrome however is common yet the protrusion acetabula are normal (2). Plain radiographs show both the AP and the sidelong part of the whole spine, patients with Marfan syndrome don't encounter disappointment of development or division of the vertebrae (3). The bend design in patients with Marfan condition is equivalent to in young adult scoliosis. Idiopathic albeit the triple curve and thoracolumbar curve are somewhat more common.

Nonsurgical treatment scoliosis with utilizing a support is viewed as less compelling. Careful treatment of spinal adjustment is shown when the magnitude of the curve surpasses 45 degrees in youths and 50 degrees in grown-ups.


Case Report

The patient was a 15-year-old male griping of a protuberance on the right half of her back. This grumbling has been capable since the patient was 10 years of age. The patient additionally has back agony and trouble strolling. The left leg is shorter than the right leg. On broad actual assessment, the patient's level was 189 cm and arm width was 154 cm. two hands giving indication long spidery finger (Arachnodactyly) and the two legs are Flatfoot (Pes Plan valgus). Anterior view got lopsidedness of the areola, shoulder. The left areola is higher, the right shoulder is higher. In the back thoracolumbar disfigurement, there was cervico-thoracic, thoracic and thoracolumbar scoliosis (Fig. 1). Bump on the right thoracic and left thoracolumbar. The cervico-thoracic, thoracic and thoracolumbar bends are inflexible. Plumb line veers off 4.3 cm from the gluteal hole. Adam test forward bowing appearance more articulated thoracic and thoracic lumbar protuberances (Fig. 2). On assessment from the foremost, back and right horizontal left, no spots were found Café au lait. Explicit tests for the assessment of Marfan condition include: Thumb (Steinberg) sign and Wrist (Walker) sign positive outcomes were acquired for both. Radiographic examinations completed include: Scoliosis view (long spine)  (Fig.3, 4) and the pelvis looks anterior-posterior and lateral shows triple bend, left cervico-thoracic, right thoracic and left thoracolumbar. On the cervico-thoracic bend, the Cobb point is 26° with the pinnacle of the bend at the cervical level 7. Major thoracic primary bend with a Cobb point of 98° has the summit of the bend at the thoracic level 6. Lumbar primary bend of 114° with the zenith of the bend at the second lumbar level. On a plain pelvic radiograph showed protrusion acetabula erring on the right side (Fig. 5). No focal point subluxation was found on eye assessment and echocardiography was inside typical cutoff points. In any case, on spirometry assessment deciphers Restrictive Impairment without impediment.




Marfan condition is an interesting problem with the skeletal sign that might create and advance during youth. Scoliosis is a typical skeletal sign influences 50-60% of the Marfan patients prompting checked deformation torment and confined versatility as the age advances (4, 5). Marfan scoliosis is tracked down in a comparative extent in the two genders. Back torment is more normal in patients with Marfan condition who additionally experience the ill effects of scoliosis than in other scoliosis patients. (6) Significant bend movement is more common in Marfan scoliosis. (7)

Forty-five percent of the patients had protrusion acetabula, with one-half of these being one-sided and one-half respective. Scoliosis was related with acetabula protrusion in 90% of cases. (8) Scoliosis present in Marfan disorder will in general advance quicker and impervious to propping when contrasted with idiopathic scoliosis.(9,10) Back torment gluteal agony is normal in patients with dural ectasia which is available in 69% of the patients impacted with Marfan syndrome. Dural ectasia is seen quite often in the lumbar region. (11) Joint hypermobility arthralgia, myalgia is normal, influencing 85% of youngsters under 18. Patients with the elements of Marfan's disorder (even without major demonstrative measures) have a high rate of moderate scoliosis, protrusion acetabula, and different foot deformations. (12)

Diagnosis is normally made by characterizing the inclusion of numerous frameworks. According to the Ghent’s Nosology the outer muscle measures expect something like 4 of the accompanying highlights ordered under the significant standards:

  1. Pectus carinatum
  2. Pectus excavatum requiring a medical procedure
  3. ULSR < 0.86 or span:height > 1.05
  4. Wrist and thumb signs
  5. Scoliosis > 200 or spondylolisthesis
  6. Diminished expansion of the elbows < 1700
  7. Pes planus
  8. Protrusio acetabulae

Or on the other hand 1 significant component with 2 of the accompanying:

  1. Pectus excavatum
  2. Joint hypermobility
  3. High angled sense of taste
  4. Dental Crowding
  5. Trademark face. (13)

Numerous patients are analyzed before the age of ten while few patients with four measures create at a later phase of their life. (14) Diagnosis is trying as it requires meaning of different clinical indication and contribution from different subject matter experts. Inability to make a conclusion or making an unseemly determination of Marfan condition has social, way of life and clinical ramifications for the person as well as the family.



The outer muscle appearances of Marfan disorder are assorted and remember the whole skeleton for different degrees. Remembering a surprising show of two-sided gluteal agony with above skeletal appearance conclusion of Marfan condition can be thought. Treatments choices fluctuate as indicated by the seriousness of side effects introduced by patients and are aimed at the symptomatology and this case report accentuates the significance of an itemized scoliosis remedy system for the rectification of both sagittal and coronal pay because of scoliosis exasperated by Protrusion acetabula.


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3. Gjolaj et al., Optimizing Outcomes in the Management of Degenerative Spondylolisthesis 1, pages 30–38 (2012)

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9. Shirley ED, Sponseller PD. Marfan syndrome. J Am Acad Orthop Surg. 2009 Sep; 17(9):572 -581.

10. Sponseller PD, Bhimani M, Solacoff D, Dormans JP. Results of brace treatment of scoliosis in Marfan syndrome. Spine. 2000 Sep 15;25(18):2350-2354.

11. Dural ectasia in Marfan syndrome and other hereditary connective tissue disorders: a 10-year follow-up study T. B€oker et al. / The Spine Journal 19 (2019) 1412−1421.

12. Musculo-skeletal Abnormalities in patients with Marfan syndrome. Kaissi et al.  Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders 2013:6 1–9

13. Dean JC Marfan syndrome: clinical diagnosis and management. Eur J Hum Genet. 2007 Jul; 15(7):724-33. Epub 2007 May.

14. Van de Velde S, Fillman R, Yandow S. Protrusio acetabuli in Marfan syndrome. History, diagnosis, and treatment. J Bone Joint Surg Am. 2006 Mar; 88(3):639-46.

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