Bone Abstracts

Objective: Existing case series examining outcomes following spine surgery for patients with skeletal dysplasias demonstrate high rates of complications. Yet, these earlier studies are from a single institution, contain surgeries performed almost 50 years ago, and only include patients with a diagnosis of achondroplasia. The objective is to determine contemporary outcomes after spinal surgery in patients with skeletal dypslasias, focusing on complications and revisions. We predict that advancements in spine surgical techniques should result in lower rates of complications and revisions in patients with skeletal dysplasias.

Methods: 37 consecutive patients who underwent spinal surgery between 2007 and 2017 were identified from our skeletal dysplasia registry. A chart review was conducted to determine patient demographics, medical/surgical history, surgical diagnoses, complications, and revision surgeries. Seven patients were excluded due to incomplete data, leaving 30 patients available for inclusion. Charlson comorbidity indices were calculated as a composite measure of overall health.

Results: Achondroplasia was the most common skeletal dysplasia (67%) followed by spondyloepiphyseal dysplasia (20%) and diastrophic dysplasia (7%). Average age of the cohort was 40 (range 6–75), and the majority of patients were in excellent health (60% Charlson Comorbidity Index .1). Indications for surgery ranged from cauda equina syndrome to symptomatic osteochondroma. The most commonly performed surgery was a multilevel thoracolumbar decompression without fusion (57%). The overall rate of complications was high: durotomy (37%), infection (13%), and neurologic complication (10%). Seven patients (23%) required revision surgery and four patients (13%) required extension of a previous decompression due to ongoing symptoms. No patient was revised for instability.

Conclusion: Surgical complication rates following spine surgery remain high in many forms of skeletal dysplasias, even with modern surgical techniques. Medical complications have decreased, likely due to improved perioperative care and may also reflect better care in the pediatric years. Revisions and extensions for persistent stenosis are common.

Disclosure: Advisory Board or Panel. Alexion – Speaker’s Bureau. Ascendis – Advisory Board or Panel.