Surgical treatment of scoliosis in Marfan syndrome: guidelines for a successful outcome.

Twenty-three patients with Marfan syndrome who had a posterior spinal arthrodesis, with or without instrumentation, autogenous iliac crest bone graft, and postoperative immobilization were retrospectively reviewed to formulate guidelines for the treatment of scoliosis. Patients in group 1 (7 patients) had both the primary and secondary curves arthrodesed, whereas patients in group 2 (16 patients) underwent selective arthrodesis of the entire primary and a partial arthrodesis of the secondary curves. Thirteen patients had triple curves, nine had double curves, and one patient had a single curve. At the time of follow-up all patients in group 1 had minimal or no progression of their curves, whereas 5 patients in group 2 had minimal or no progression and 11 had marked progression of at least one curve. There were no pseudarthroses or hardware failures. The authors recommend arthrodesing both the primary and secondary curves in all patients with Marfan syndrome.