Treatment of kyphosis and lumbar stenosis in achondroplasia.

In summary, neurological symptoms in the achondroplast are related to the anatomical spinal canal with degenerative changes and aging altering the delicate biomechanical and microvascular balance. An accurate and detailed history is necessary for diagnosis. Decompression is via a posterior approach with a multi-level wide laminectomy with undercutting of the facets and usually multi-level foraminotomies. Kyphosis when present at the time of decompression, or if angular or progressive, requires treatment. A combined two-stage approach with an anterior disc excision and fusion combined with a posterior and posterolateral fusion is the treatment of choice. In angular deformities anterior strut grafting is indicated. The use of instrumentation posteriorly is contraindicated with the possible exception of transpedicular fixation. The instrumentation stabilizes the spine and does to correct the deformity. Using this approach the kyphosis in the achondroplast and the symptomatic spinal stenosis are adequately treated.