title: Laminectomy in patients with achondroplasia: the impact of time to surgery on long-term function.
abstract: METHODS
  Retrospective analysis, survey.
  
  
  OBJECTIVE
  To describe a cohort of individuals with achondroplasia undergoing thoracolumbar laminectomy and to examine if shorter time to surgery was related to improvement in long-term functional outcome.
  
  
  BACKGROUND
  Data on the long-term benefits of laminectomy are mixed for such patients. Earlier intervention may be associated with greater likelihood of long-term benefit, but quantified data are lacking.
  
  
  METHODS
  We retrospectively studied 49 patients with achondroplasia who underwent primary laminectomy for spinal stenosis. Patients completed a questionnaire to assess symptoms, walking distance, and independence (per Modified Rankin Scale), before surgery and currently. Responses were analyzed for the likelihood of improved walking distance or Rankin level.
  
  
  RESULTS
  Our patients had the following mean values: age, 37.7 ± 10.6 years; body mass index, 31.8 ± 5.5; symptom duration, 74.0 ± 100.1 months; preoperative symptom severity score, 2.7 ± 1.0 points; mean changes in blocks walked, +0.39 ± 2.0; and Rankin level, +0.08 ± 1.47. Patients with a time-to-surgery interval of <6 months were 7.13 times (95% confidence interval [CI], 1.39-36.66) more likely to experience improvement in walking distance and 4.00 times (95% CI, 1.05-15.21) more likely to experience Rankin level improvement than patients whose interval was >6 months. Intervals of up to 12 and 24 months were associated with increased likelihoods of 4.95 (95% CI, 1.41-17.41) and 3.43 (95% CI, 1.05-11.22), respectively, of improved walking distance compared with those with longer time-to surgery intervals, but those Rankin level improvements were not statistically significant.
  
  
  CONCLUSIONS
  Time from symptom onset to surgery in patients with achondroplasia is an important predictor of long-term functional outcome. For sustained long-term postsurgical improvement, the window of opportunity might be relatively narrow. Patients with achondroplasia should seek medical advice for spinal stenotic symptoms as soon as possible.
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Emily Streyer
authors.initials: ES
authors.lastname: Carlisle
authors.forename: Beverlie L
authors.initials: BL
authors.lastname: Ting
authors.forename: Madeel A
authors.initials: MA
authors.lastname: Abdullah
authors.forename: Richard L
authors.initials: RL
authors.lastname: Skolasky
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Schkrohowsky
authors.forename: Mary T
authors.initials: MT
authors.lastname: Yost
authors.forename: Daniele
authors.initials: D
authors.lastname: Rigamonti
authors.forename: Michael C
authors.initials: MC
authors.lastname: Ain
mesh_terms: D000130:Achondroplasia / Q000150:complications* / Q000601:surgery*; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007796:Laminectomy / Q000592:standards; D008159:Lumbar Vertebrae / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function / Q000502:physiology*; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery*; D013130:Spinal Stenosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000503:physiopathology / Q000601:surgery; D013995:Time; D016896:Treatment Outcome