Laminectomy in Patients with Achondroplasia: The Impact of Time to Surgery on Long-Term Function

Methods: We performed a retrospective study of sixty-one patients with achondroplasia who underwent laminectomy for spinal stenosis at our institution. Patients completed a questionnaire to assess symptoms, walking distance, and independence (assessed via Modified Rankin Scale), preoperatively and currently. Responses were analyzed for the impact of time to surgery on the likelihood of experiencing improved walking distance or Rankin level at the time of the survey.

Results: Patients with a time-to-surgery interval of less than six months were 6.22 times (95% confidence interval, 1.54 to 25.15) more likely to experience improvement in walking distance and 3.6 times (95% confidence interval, 1.03 to 12.54) more likely to experience improvement in Rankin level than patients whose time-to-surgery interval was more than six months. Intervals of up to twelve and eighteen months were associated with increased likelihoods of 5.14 (95% confidence interval, 1.69 to 15.69) and 4.41 (95% confidence interval, 1.46 to 12.78), respectively, of improved walking distance compared with those with longer time-to surgery intervals, but improvement in Rankin level was not significant for those times. Surgery after an interval of up to twenty-four months did not result in significant improvement based on either type of assessment.

Conclusions: The interval from onset of symptoms to surgery in achondroplastic patients is an important predictor of long-term functional outcome. For the surgery to provide sustained long-term improvement, the window of opportunity might be relatively narrow. Patients with achondroplasia should be urged to seek medical advice for spinal stenotic symptoms as soon as possible.