Laminectomy in patients with achondroplasia: The impact of time to surgery on long-term function

Emily Streyer Carlisle, Beverlie L. Ting, Madeel A. Abdullah, Richard L. Skolasky, Joshua G. Schkrohowsky, Mary T. Yost, Daniele Rigamonti, Michael C. Ain

Research output: Contribution to journalArticle

Abstract

Study Design.: Retrospective analysis, survey. Objective.: To describe a cohort of individuals with achondroplasia undergoing thoracolumbar laminectomy and to examine if shorter time to surgery was related to improvement in long-term functional outcome. Summary of Background Data.: Data on the long-term benefits of laminectomy are mixed for such patients. Earlier intervention may be associated with greater likelihood of long-term benefit, but quantified data are lacking. Methods.: We retrospectively studied 49 patients with achondroplasia who underwent primary laminectomy for spinal stenosis. Patients completed a questionnaire to assess symptoms, walking distance, and independence (per Modified Rankin Scale), before surgery and currently. Responses were analyzed for the likelihood of improved walking distance or Rankin level. Results.: Our patients had the following mean values: age, 37.7 ± 10.6 years; body mass index, 31.8 ± 5.5; symptom duration, 74.0 ± 100.1 months; preoperative symptom severity score, 2.7 ± 1.0 points; mean changes in blocks walked, +0.39 ± 2.0; and Rankin level, +0.08 ± 1.47. Patients with a time-to-surgery interval of <6 months were 7.13 times (95% confidence interval [CI], 1.39-36.66) more likely to experience improvement in walking distance and 4.00 times (95% CI, 1.05-15.21) more likely to experience Rankin level improvement than patients whose interval was >6 months. Intervals of up to 12 and 24 months were associated with increased likelihoods of 4.95 (95% CI, 1.41-17.41) and 3.43 (95% CI, 1.05-11.22), respectively, of improved walking distance compared with those with longer time-tosurgery intervals, but those Rankin level improvements were not statistically significant. Conclusion.: Time from symptom onset to surgery in patients with achondroplasia is an important predictor of long-term functional outcome. For sustained long-term postsurgical improvement, the window of opportunity might be relatively narrow. Patients with achondroplasia should seek medical advice for spinal stenotic symptoms as soon as possible.

Original languageEnglish (US)
Pages (from-to)886-892
Number of pages7
JournalSpine
Volume36
Issue number11
DOIs
StatePublished - May 15 2011

Keywords

  • Laminectomy
  • achondroplasia
  • long-term outcome

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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