P30. Surgery for spinal stenosis in achondroplasia: causes of reoperation and reduction of risks

BACKGROUND CONTEXT Individuals with achondroplasia are prone to symptomatic spinal stenosis requiring surgery. Revision rates are thought to be high, however, the precise causes and rates of re-operation are unknown. PURPOSE The primary aim of this study is to investigate the causes of re-operation after initial surgical intervention in individuals with achondroplasia and spinal stenosis. Additionally, we report on surgical techniques aimed at reducing the risks of these reoperations. STUDY DESIGN/SETTING Retrospective Cohort. PATIENT SAMPLE A total of 130. OUTCOME MEASURES Number of revision, pseudarthroses, proximal junctional kyphosis, new neurologic finding. METHODS A retrospective review was conducted over an 8-year period of all patients with achondroplasia at a single institution that serves as a large referral center for patients with skeletal dysplasias. Patients with achondroplasia who underwent spinal surgery for stenosis were identified and the need for revision surgery was studied. Data collected included demographic, surgical, and revision details. Fisher's exact test was used to determine if an association existed between construct type and need for revisions. RESULTS Thirty-three of the 130 (21.5%) patients with achondroplasia required spinal stenosis surgery. 24 individuals who met the criteria were selected for analysis. The initial spine surgery was at an average age of 18.7 years (SD 10.1 years). Nine patients (37.5%) required revision surgeries, 3 required multiple revisions. 5 of 9 (55.6%) of the revisions had primary surgery at an outside institution. Revision surgeries were due to caudal pseudarthrosis (8), proximal junctional kyphosis (PJK) (7), and new neurological symptoms (7). There was a significant association found between construct type and the need for revision (p = 0.0111). Pairwise comparison found that short fusions were significantly associated with need for revision compared with the interbody group (p = 0.0180). PJK was associated with short fusions when compared with the long fusion group (p = 0.0294) and with the interbody group (p = 0.0300). Caudal pseudarthrosis was associated with short fusions when compared with the interbody group (p = 0.0015). Multivariate logistic regression found long fusion with an interbody was predictive for and protective against the need for revision surgery (p = 0.0246). To date, none of the initial cases that had long fusions with caudal interbody required a revision for distal pseudarthrosis. CONCLUSIONS In patients with achondroplasia, rate of surgery for spinal stenosis is 21.5% and the risk of revision is 37.5% and is primarily due to pseudarthrosis, PJK, and recurrent neurologic symptoms. Surgeons should consider discussing spinal surgery as part of the patient's life plan and should consider wide decompression of the stenotic levels and long fusion with use of interbody cage at the caudal level in all patients to reduce risks of revision. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs.