Among the skeletal dysplasias, spinal deformity is seen most commonly in patients with achondroplasia. 




1.  Thoracolumbar kyphosis


Occurs in almost all patients prior to walking

- non rigid, likely due to hypotonia

- resolves with ambulation


Bracing may help to prevent clinically significant kyphosis

- persists in approximately 15% to 20% of patients


2.  Spinal Stenosis



- Short pedicles

- narrow interpedicular distance 

- Stenosis may be present at any level from the foramen magnum down

- most commonly L1-S1




Over 50% of patients with achondroplasia have back pain

- other symptoms may include leg pain, claudication, paresthesias, weakness, and paraplegia. 

- Bowel and bladder difficulties may occur with stenosis in the lower thoracic spine


Symptoms usually occur in early adulthood and are slowly progressive

- Occasionally, symptoms may arise in childhood


Surgical decompression


Wide, multilevel laminectomies

- Disc removal usually is not indicated 

- unless radiculopathy is present

- Early surgical intervention leads to a better outcome


Postlaminectomy instability may occur

- fusion probably should be added in cases of multilevel decompression


3.  TL kyphosis + stenosis


Anterior decompression and strut grafting should be added