Spinal Stenosis in Achondroplasia - A Case Report and Review of the Literature

Achondroplasia, the most common skeletal dysplasia, often presents with congenital lumbar spinal stenosis. In skeletally mature adults without instability, the choice between decompression alone and decompression with fusion remains debated.

A 21-year-old male with achondroplasia presented with progressive neurogenic claudication and bilateral extensor hallucis longus weakness. Magnetic resonance imaging showed multilevel stenosis (L1-L5) from congenitally short pedicles and ligamentum flavum hypertrophy, without instability. He underwent L1-L5 laminectomy and flavectomy without instrumentation. At 2-year follow-up, neurological function was sustained with no recurrence or instability.

Adult achondroplasia patients with preserved stability may benefit from decompression alone, avoiding the added morbidity of fusion. Careful patient selection, early intervention, and meticulous technique are key to good long-term outcomes.Multilevel decompression without fusion can be an effective, durable option for lumbar stenosis in skeletally mature achondroplasia patients when stability is intact.