Surgical treatment of spinal stenosis in achondroplasia: Literature review comparing results in adults and paediatrics

Zaid Abu Al-Rub; Beth Lineham; Zaid Hashim; John Stephenson; Lydia Arnold; Jennifer Campbell; Peter Loughenbury; Almas Khan

doi:10.1016/j.jcot.2021.101672

Surgical treatment of spinal stenosis in achondroplasia: Literature review comparing results in adults and paediatrics

J Clin Orthop Trauma. 2021 Oct 30:23:101672. doi: 10.1016/j.jcot.2021.101672. eCollection 2021 Dec.

Authors

Zaid Abu Al-Rub¹, Beth Lineham¹, Zaid Hashim¹, John Stephenson², Lydia Arnold², Jennifer Campbell³, Peter Loughenbury⁴, Almas Khan⁴

Affiliations

¹ Health Education England, Yorkshire and Humber Deanery, United Kingdom.
² Department of Allied Health Professions Sport and Exercise, School of Human and Health Sciences, University of Huddersfield, Huddersfield, West Yorkshire, United Kingdom.
³ Department of Clinical Genetics, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, United Kingdom.
⁴ Department of Spine Surgery, Centre for Neurosciences, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, United Kingdom.

Abstract

Background: This study aims to assess the quantity and quality of available literature on surgical treatment outcomes of spinal stenosis in adult and paediatric achondroplasia patients through a systematic review of literature and to investigate the suitability of conducting a meta-analysis on outcomes of surgical treatment.

Methods: Online databases were searched according to PRISMA guidelines. No restrictions regarding study design, sample size, previous treatment, or publication date were implemented. The following terms: "Spinal stenosis", "Spinal Decompression", "Spinal fusion", each term separately combined with the term "Achondroplasia" were used. Quality of the included studies were assessed used the Modified Coleman method.

Results: Five adult and four paediatric single-sample non-comparative studies were identified for inclusion (176 adult and 102 paediatric patients). Meta-analyses assessed the proportion of patients achieving full resolution of symptoms to be 0.51 (95% CI 0.00 to 1.00); the proportion of patients achieving full or partial resolution of symptoms to be 0.90 (95% CI 0.84 to 0.97); the proportion of procedures requiring re-operation to be 0.42 (95% CI 0.34 to 0.50; and the proportion of procedures involving dural tears to be 0.20 (95% CI 0.02 to 0.39). Statistical heterogeneity was very high for full resolution of symptoms and requirement for dural repair; and very low for other outcomes.

Conclusions: The available literature on this population and condition is sparse, highly heterogenous, and is generally of low quality limiting the value of meta-analysis. Overall, outcomes of surgical decompression of symptomatic spinal stenosis in achondroplasia patients show consistent degree of resolution of symptoms. Duration of symptoms prior to surgical treatment appears to play an important role in the overall outcome of treatment. Therefore, a delay in diagnosis and treatment can potentially be detrimental in achieving a better outcome.

Keywords: Achondroplasia; Adults; Paediatrics; Spine; Stenosis.