Dr. Feldman: My Approach to Spinal Stenosis in Achondroplasia
My Approach to Spinal Stenosis in Achondroplasia:As I treat individuals with Achondroplasia from throughout the world and of all ages, spinal stenosis with its inherent pain, weakness and eventual bladder and bowel dysfunction, is the most frequent complaint and reason for disability. From an eight-year-old boy living in continuous pain who could not rest to a 60-year-old woman who can no longer walk in her home, spinal stenosis influences all ages in Achondroplasia. IT IS PREVENTABLE AND TREATABLE.
Annual examinations and discussions of symptoms are needed. If symptoms are occurring, even mild, an MRI will confirm the extent and position of the spinal compression. Surgery to decompress the stenosis to unroof the compression is often curative.
Fusion is essential if the decompression needs removal of the joints or kyphosis (hunch back), as often encountered in Achondroplasia. I usually hear, “OH not a fusion- that is terrible”. Untrue- when performed correctly and for the proper indications, it enables the individuals to return to everyday life. It is not easy and recovering, but it is often the only way to evade ending up with an unfortunate spinal deformity after decompression. To improve the fusion, I now do a minimally invasive side surgery simultaneously at the lowest level to assure fusion, which is a problem when a lot of bone is removed to decompress. To decompress, I utilize an ultrasonic scalpel which is more precise, safer, and involves much less blood loss.
Below is a questionnaire that we administer to all of our Achondroplastic patients and none of us at the Paley Institute would lengthen a patient until their spine is cleared.