Surgical and anaesthesia decision making algorithms in patients with congenital spinal stenosis: a case report of awake endoscopic decompression in a patient with achondroplasia and literature review.

Abstract

Individuals with achondroplasia are prone to lumbar stenosis with a common need for spinal decompression surgery. However, given anatomical and medical factors, this population is at increased risk for surgical and anaesthetic complications, thus posing a unique challenge to the clinicians. The use of an awake minimally invasive endoscopic technique under monitored anaesthesia care may prove beneficial to mitigate such risks. We present a case of a 52 year old female with achondroplasia suffering from left radicular leg pain. A Magnetic Resonance Imaging scan showed severe lumbar spinal stenosis and lateral recess stenosis at L4/5 and L5/S1, with compression of the descending L5 and S1 nerve roots respectively. There was also moderate foraminal stenosis at both levels with compression of exiting L4 and L5 nerve roots respectively. The patient underwent awake endoscopic decompression utilising a uniportal interlaminar endoscopic system under local anaesthesia with sedation. The patient recovered well post-operatively, with immediate resolution of her symptoms. She was ambulating up to 100 m on postoperative day one. The awake endoscopic procedure described is an option that may be well suited for patients with achondroplasia presenting with lumbar stenosis.