Isolated subaxial cervical spine stenosis in achondroplasia

Although isolated subaxial cervical spine stenosis in achondroplasia is less common than narrowing at the foramen magnum, thoracolumbar junction, or lumbar spine, it should be recognized as a distinct entity. These congenital changes usually become symptomatic when combined with degenerative changes in early adult life. Yearly monitoring of adult achondroplastic patients for signs and symptoms of cervical myelopathy or radiculopathy is recommended. When this develops, early surgical decompression should be considered, as these patients generally do not respond well to nonoperative treatment. The altered anatomy and small size make these cases particularly challenging. A thorough history and examination and complete diagnostic testing are necessary to gain an understanding of the exact etiology of the symptoms. Wide laminectomies and foraminotomies are then usually required to decompress the spinal cord and nerve roots. Fusion using internal fixation may be required to stabilize the spine if excessive bone is removed. (Curr Surg 57:354-356)