Leg-length discrepancy and scoliosis in Marfan syndrome

Leg-length discrepancy (LLD) greater than 2 cm is rare in the general population and is associated with a lumbar postural scoliosis; it has not been studied in the setting of Marfan syndrome. Thirteen LLDs of 2 cm or more were recorded from a group of 250 Marfan patients visiting a medical genetics clinic for complete care. Diagnosis was confirmed by standing anteroposterior pelvic radiograph and/or scanogram. Records and anteroposterior radiographs of the spine were reviewed to obtain Cobb angles for spinal curvatures. A mean discrepancy of 3.2 +/- 1.0 cm and a Cobb angle of 37.0 degrees +/- 28.4 degrees were found. Twelve of 13 curves were convex toward the shorter leg, caudally. Twelve patients had scoliosis greater than 10 degrees. Five curves were severe and progressive, suggesting the need for spinal fusion and prior equalization of leg lengths. LLD correlated weakly with Cobb angle. LLD is more common in individuals with Marfan syndrome than in the general population and is associated with increased structural scoliosis.