Single-staged kyphoscoliosis correction using Smith-Petersen’s osteotomy (SPO) in an adolescent with severe thoracolumbar kyphoscoliosis and Marfanoid habitus: a case report

Introduction: Marfanoid individuals exhibit certain phenotypic features similar to those of Marfan syndrome; however, they do not fulfill the diagnostic criteria required for it. Spinal deformities are characteristic of Marfanoid syndrome and can worsen with age. This case report presents a unique case of an adolescent presenting with Marfanoid habitus and severe thoracolumbar kyphoscoliosis. Case presentation: A 16-year-old boy with Marfanoid features presented with a progressive spinal deformity and concomitant back pain and esthetic complaint for 6 years. Physical examination revealed pectus carinatum, as well as anthropometric features consistent with Marfan syndrome, including arachnodactyly, retinitis pigmentosa, and flat feet. However, no cardiovascular or neurological concerns were noted. Imaging findings demonstrated a kyphotic angle of 92.3° and scoliosis measuring 41.2°. The patient was diagnosed with thoracolumbar kyphoscoliosis in Marfanoid habitus. Clinical discussion: Surgical management included posterior spinal fusion with two rod constructs and bone grafting at the 13 vertebrae osteotomy levels, such as in a Smith-Petersen osteotomy (SPO). Significant postoperative correction was achieved with kyphosis and scoliosis measuring 11.9° and 10.2°, respectively. Rapid functional recovery with SF-36 scores improved over 6 months. This case demonstrates the utility of SPO and Cantilever techniques in achieving structural and functional improvement in complex spinal deformities associated with Marfanoid features. Conclusion: Thoracolumbar kyphoscoliosis in Marfanoid individuals can be effectively managed with single-stage SPO and Cantilever correction. Early surgical intervention and postoperative orthosis play a crucial role in achieving favorable outcomes and enhancing quality of life.