1. Spinal Surgery in Achondroplasia: Outcome Analysis and Risk Factors for Impending Neurologic Deficit
John A. Heydemann, MD; Oussama Abousamra, MD;
Tyler Kreitz, MD; Kenneth J. Rogers, PhD; Colleen Ditro, DNP, CPNP;
Suken A. Shah, MD; William G. Mackenzie, MD

2. Background • Thoracolumbar kyphosis (TLK) often resolves
• Occasionally curve progresses
• Spinal stenosis treated with laminectomy and fusion

3. Methods • Surgery for symptomatic stenosis due to TLK • Compared to:
Within surgical group
Non-surgical matched group

4. Surgical group 26 children
p values
Preop
Postop
LFU
Preop vs. Postop
Postop vs. LFU
Mean SD
Thoracic Kyphosis 14 24 28 16 30 17
0.025
0.543
Lumbar Lordosis 55 27 41 20
0.059
0.990
Thoracolumbar Kyphosis 42 33 10 9
0.0001
0.930
Pelvic Incidence 48 44 19 49
0.434
0.358
T1 Pelvic Angle 3 18 -2 21
0.364
0.443
Sagittal Balance (mm) 46 13 12
0.589
0.989
Results
Table1: Sagittal spinopelvic measurements perioperatively and during follow up. SD: standard deviation.
Surgical Group (26 Children)
Control Group (196 Children)
p values
Mean SD
Age (years)
13.2
4.3
11.2
4.9
0.02
Thoracic Kyphosis 14 24 18 12
0.422
Lumbar Lordosis 55 27 64 17
0.099
Thoracolumbar Kyphosis 42 33
0.0003
Pelvic Incidence 48 20 49 16
0.969
T1 Pelvic Angle 3 -8 9
0.003
Sagittal Balance (mm) 46 -6 28
0.009
Table2: Comparison between the surgical and control group. SD: standard deviation.

5. Results
Conclusions
• 21/26 neurologic complaints resolved postoperatively
• Surgical group higher TLK and positive sagittal balance
• Thoracic kyphosis, and TLK improved significantly
• Un-resolving TLK is associated with increased risk of neurologic deficit 
• Unresolved TLK by age 10
Increase surveillance
Discuss prophylactic surgery
Increased propensity for neurologic deficit

6. References
• Fairbank, J. C. T., & Pynsent, P. B. (n.d.). The Oswestry Disability Index. SPINE, 25(22), 2940–2953.
• Hong, J.-Y., Suh, S.-W., Modi, H. N., Park, J.-W., & Park, J.-H. (2011). Analysis of Sagittal Spinopelvic Parameters in Achondroplasia. Spine.
• Kamac, S., Yücekul, A., Demirkran, G., Berktaş, M., & Yazc, M. (2015). The Evolution Of Sagittal Spinal Alignment In Sitting Position During Childhood. Spine.
• Karikari, I. O., Mehta, A. I., Solakoglu, C., Bagley, C. A., Ain, M. C., & Gottfried, O. N. (2012). Sagittal spinopelvic parameters in children with achondroplasia: identification of 2 distinct groups. Journal of Neurosurgery: Spine.
• Kumc. (2008). SRS-22r Patient Questionnaire.
• Protopsaltis, T., Schwab, F., Bronsard, N., Smith, J. S., Klineberg, E., Mundis, G., … Lafage, V. (2014). The T1 Pelvic Angle, a Novel Radiographic Measure of Global Sagittal Deformity, Accounts for Both Spinal Inclination and Pelvic Tilt and Correlates with Health-Related Quality of Life. Journal of Bone and Joint Surgery, 96, 1631–
• Saygin Kamaci , MD , Altug Yucekul , MD ,  Gokhan Demirkiran , MD , Mehmet Berktas , MD, and, & Muharrem Yazici, M. (2015). The Evolution of Sagittal Spinal Alignment in sitting position during childhood. Spine, 40(13), E787–E793.
• Schkrohowsky, J. G., Hoernschemeyer, D. G., Carson, B. S., & Ain, M. C. (2007). Early presentation of spinal stenosis in achondroplasia. Journal of Pediatric Orthopedics.
• Baca, K. E., Abdullah, M. A., Ting, B. L., Schkrohowsky, J. G., Hoernschemeyer, D. G., Carson, B. S., & Ain, M. C. (2010). Surgical Decompression for Lumbar Stenosis in Pediatric Achondroplasia. J Pediatr Orthop, 30, 449–454.
• Borkhuu, B., Nagaraju, D. K., Chan, G., Holmes, L., & Mackenzie, W. G. (2009). Factors Related to Progression of Thoracolumbar Kyphosis in Children With Achondroplasia A Retrospective Cohort Study of Forty-Eight Children Treated in a Comprehensive Orthopaedic Center. SPINE, 3434(16).
• Cil, A., Yazici, M., Uzumcugil, A., Kandemir, U., Alanay, A., Alanay, Y., … Surat, A. (2005). The evolution of sagittal segmental alignment of the spine during childhood. Spine.
• DANIEL M. SCIUBBA, M.D., JOSEPH C. NOGGLE, B.S., NEENA I. MARUPUDI, M. S., CARLOS A. BAGLEY, M.D.,1 MARKUS J. BOOKLAND, M.D.,1 BENJAMIN S. CARSON SR., M. D., & • MICHAEL C. AIN, M.D., AND GEORGE I. JALLO, M. D. (2007). Spinal stenosis surgery in pediatric patients with achondroplasia. Journal of Neurosurgery: Pediatrics, 106, 372–378.
• Engberts, A. C., Jacobs, W. C. H., Castelijns, S. J. A. M., Castelein, R. M., & Vleggeert-Lankamp, C. L. A. (2012). The prevalence of thoracolumbar kyphosis in achondroplasia: A systematic review. Journal of Children’s Orthopaedics.

7. Thank You