Spinal stenosis surgery in pediatric patients with achondroplasia

Daniel M. Sciubba, Joseph C. Noggle, Neena I. Marupudi, Carlos A. Bagley, Markus J. Bookland, Benjamin S. Carson, Michael C. Ain, George I. Jallo

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Object. Achondroplasia is a hereditary form of dwarfism caused by a defect in endochondral bone formation, resulting in skeletal abnormalities including short stature, shortened limb bones, macrocephaly, and small vertebral bodies. In the pediatric population, symptomatic spinal stenosis occurs at all spinal levels due to the abnormally narrow bone canal. In this study, clinical outcomes were assessed in children with achondroplasia after spinal canal decompression. Methods. A retrospective review was conducted involving pediatric patients with heterozygous achondroplasia and symptomatic stenosis after decompressive procedures at the authors' institution within a 9-year period. Measured outcomes included resolution of symptoms, need for repeated surgery, presence of fusion, development of deformity, and complications. Forty-four pediatric patients underwent a total of 60 decompressive procedures. The average patient age at surgery was 12.7 years (range 5-21 years). Forty-nine operations were performed for initial treatment of stenosis, and 11 were performed as revision surgeries on previously operated levels. A large proportion of patients (> 60%) required additional cervicomedullary decompressions, most often preceding the symptoms of spinal stenosis. Of the initial procedures, decompression locations included 32 thoracolumbar (65%), 10 lumbar (20%), four cervical (8%), two cervicothoracic (4%), and one thoracic (2%). Forty-three of the decompressive procedures (72%) included spinal fusion procedures. Of the 11 revisions, five were fusion procedures for progressive deformity at levels previously decompressed but not fused (all thoracolumbar), five were for decompressions of symptomatic junctional stenosis with extension of fusion, and one was for repeated decompression at the same level due to recurrence of symptomatic stenosis. Conclusions. Decompression of the spinal canal in pediatric patients with achondroplasia can be accomplished safely with significant clinical benefit. Patients with a history of cervicomedullary compression may be at an increased risk of developing symptomatic stenosis prior to adolescence. Fusion procedures are recommended in patients with a large decompression overlying a thoracolumbar kyphosis to avoid progressive postoperative deformity.

Original languageEnglish (US)
Pages (from-to)372-378
Number of pages7
JournalJournal of Neurosurgery
Volume106
Issue number5 SUPPL.
StatePublished - May 1 2007

Fingerprint

Achondroplasia
Spinal Stenosis
Decompression
Pediatrics
Pathologic Constriction
Spinal Canal
Megalencephaly
Bone and Bones
Dwarfism
Spinal Fusion
Kyphosis
Reoperation
Osteogenesis
Thorax
Extremities
Recurrence

Keywords

  • Achondroplasia
  • Cervicomedullary compression
  • Decompression surgery
  • Pediatric neurosurgery
  • Spinal fusion
  • Spinal stenosis

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Clinical Neurology

Cite this

Sciubba, D. M., Noggle, J. C., Marupudi, N. I., Bagley, C. A., Bookland, M. J., Carson, B. S., ... Jallo, G. I. (2007). Spinal stenosis surgery in pediatric patients with achondroplasia. Journal of Neurosurgery, 106(5 SUPPL.), 372-378.

Spinal stenosis surgery in pediatric patients with achondroplasia. / Sciubba, Daniel M.; Noggle, Joseph C.; Marupudi, Neena I.; Bagley, Carlos A.; Bookland, Markus J.; Carson, Benjamin S.; Ain, Michael C.; Jallo, George I.

In: Journal of Neurosurgery, Vol. 106, No. 5 SUPPL., 01.05.2007, p. 372-378.

Research output: Contribution to journalArticle

Sciubba, DM, Noggle, JC, Marupudi, NI, Bagley, CA, Bookland, MJ, Carson, BS, Ain, MC & Jallo, GI 2007, 'Spinal stenosis surgery in pediatric patients with achondroplasia', Journal of Neurosurgery, vol. 106, no. 5 SUPPL., pp. 372-378.
Sciubba DM, Noggle JC, Marupudi NI, Bagley CA, Bookland MJ, Carson BS et al. Spinal stenosis surgery in pediatric patients with achondroplasia. Journal of Neurosurgery. 2007 May 1;106(5 SUPPL.):372-378.
Sciubba, Daniel M. ; Noggle, Joseph C. ; Marupudi, Neena I. ; Bagley, Carlos A. ; Bookland, Markus J. ; Carson, Benjamin S. ; Ain, Michael C. ; Jallo, George I. / Spinal stenosis surgery in pediatric patients with achondroplasia. In: Journal of Neurosurgery. 2007 ; Vol. 106, No. 5 SUPPL. pp. 372-378.
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abstract = "Object. Achondroplasia is a hereditary form of dwarfism caused by a defect in endochondral bone formation, resulting in skeletal abnormalities including short stature, shortened limb bones, macrocephaly, and small vertebral bodies. In the pediatric population, symptomatic spinal stenosis occurs at all spinal levels due to the abnormally narrow bone canal. In this study, clinical outcomes were assessed in children with achondroplasia after spinal canal decompression. Methods. A retrospective review was conducted involving pediatric patients with heterozygous achondroplasia and symptomatic stenosis after decompressive procedures at the authors' institution within a 9-year period. Measured outcomes included resolution of symptoms, need for repeated surgery, presence of fusion, development of deformity, and complications. Forty-four pediatric patients underwent a total of 60 decompressive procedures. The average patient age at surgery was 12.7 years (range 5-21 years). Forty-nine operations were performed for initial treatment of stenosis, and 11 were performed as revision surgeries on previously operated levels. A large proportion of patients (> 60{\%}) required additional cervicomedullary decompressions, most often preceding the symptoms of spinal stenosis. Of the initial procedures, decompression locations included 32 thoracolumbar (65{\%}), 10 lumbar (20{\%}), four cervical (8{\%}), two cervicothoracic (4{\%}), and one thoracic (2{\%}). Forty-three of the decompressive procedures (72{\%}) included spinal fusion procedures. Of the 11 revisions, five were fusion procedures for progressive deformity at levels previously decompressed but not fused (all thoracolumbar), five were for decompressions of symptomatic junctional stenosis with extension of fusion, and one was for repeated decompression at the same level due to recurrence of symptomatic stenosis. Conclusions. Decompression of the spinal canal in pediatric patients with achondroplasia can be accomplished safely with significant clinical benefit. Patients with a history of cervicomedullary compression may be at an increased risk of developing symptomatic stenosis prior to adolescence. Fusion procedures are recommended in patients with a large decompression overlying a thoracolumbar kyphosis to avoid progressive postoperative deformity.",
keywords = "Achondroplasia, Cervicomedullary compression, Decompression surgery, Pediatric neurosurgery, Spinal fusion, Spinal stenosis",
author = "Sciubba, {Daniel M.} and Noggle, {Joseph C.} and Marupudi, {Neena I.} and Bagley, {Carlos A.} and Bookland, {Markus J.} and Carson, {Benjamin S.} and Ain, {Michael C.} and Jallo, {George I.}",
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T1 - Spinal stenosis surgery in pediatric patients with achondroplasia

AU - Sciubba, Daniel M.

AU - Noggle, Joseph C.

AU - Marupudi, Neena I.

AU - Bagley, Carlos A.

AU - Bookland, Markus J.

AU - Carson, Benjamin S.

AU - Ain, Michael C.

AU - Jallo, George I.

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N2 - Object. Achondroplasia is a hereditary form of dwarfism caused by a defect in endochondral bone formation, resulting in skeletal abnormalities including short stature, shortened limb bones, macrocephaly, and small vertebral bodies. In the pediatric population, symptomatic spinal stenosis occurs at all spinal levels due to the abnormally narrow bone canal. In this study, clinical outcomes were assessed in children with achondroplasia after spinal canal decompression. Methods. A retrospective review was conducted involving pediatric patients with heterozygous achondroplasia and symptomatic stenosis after decompressive procedures at the authors' institution within a 9-year period. Measured outcomes included resolution of symptoms, need for repeated surgery, presence of fusion, development of deformity, and complications. Forty-four pediatric patients underwent a total of 60 decompressive procedures. The average patient age at surgery was 12.7 years (range 5-21 years). Forty-nine operations were performed for initial treatment of stenosis, and 11 were performed as revision surgeries on previously operated levels. A large proportion of patients (> 60%) required additional cervicomedullary decompressions, most often preceding the symptoms of spinal stenosis. Of the initial procedures, decompression locations included 32 thoracolumbar (65%), 10 lumbar (20%), four cervical (8%), two cervicothoracic (4%), and one thoracic (2%). Forty-three of the decompressive procedures (72%) included spinal fusion procedures. Of the 11 revisions, five were fusion procedures for progressive deformity at levels previously decompressed but not fused (all thoracolumbar), five were for decompressions of symptomatic junctional stenosis with extension of fusion, and one was for repeated decompression at the same level due to recurrence of symptomatic stenosis. Conclusions. Decompression of the spinal canal in pediatric patients with achondroplasia can be accomplished safely with significant clinical benefit. Patients with a history of cervicomedullary compression may be at an increased risk of developing symptomatic stenosis prior to adolescence. Fusion procedures are recommended in patients with a large decompression overlying a thoracolumbar kyphosis to avoid progressive postoperative deformity.

AB - Object. Achondroplasia is a hereditary form of dwarfism caused by a defect in endochondral bone formation, resulting in skeletal abnormalities including short stature, shortened limb bones, macrocephaly, and small vertebral bodies. In the pediatric population, symptomatic spinal stenosis occurs at all spinal levels due to the abnormally narrow bone canal. In this study, clinical outcomes were assessed in children with achondroplasia after spinal canal decompression. Methods. A retrospective review was conducted involving pediatric patients with heterozygous achondroplasia and symptomatic stenosis after decompressive procedures at the authors' institution within a 9-year period. Measured outcomes included resolution of symptoms, need for repeated surgery, presence of fusion, development of deformity, and complications. Forty-four pediatric patients underwent a total of 60 decompressive procedures. The average patient age at surgery was 12.7 years (range 5-21 years). Forty-nine operations were performed for initial treatment of stenosis, and 11 were performed as revision surgeries on previously operated levels. A large proportion of patients (> 60%) required additional cervicomedullary decompressions, most often preceding the symptoms of spinal stenosis. Of the initial procedures, decompression locations included 32 thoracolumbar (65%), 10 lumbar (20%), four cervical (8%), two cervicothoracic (4%), and one thoracic (2%). Forty-three of the decompressive procedures (72%) included spinal fusion procedures. Of the 11 revisions, five were fusion procedures for progressive deformity at levels previously decompressed but not fused (all thoracolumbar), five were for decompressions of symptomatic junctional stenosis with extension of fusion, and one was for repeated decompression at the same level due to recurrence of symptomatic stenosis. Conclusions. Decompression of the spinal canal in pediatric patients with achondroplasia can be accomplished safely with significant clinical benefit. Patients with a history of cervicomedullary compression may be at an increased risk of developing symptomatic stenosis prior to adolescence. Fusion procedures are recommended in patients with a large decompression overlying a thoracolumbar kyphosis to avoid progressive postoperative deformity.

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KW - Cervicomedullary compression

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KW - Pediatric neurosurgery

KW - Spinal fusion

KW - Spinal stenosis

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