Intraoperative dural tears secondary to lumbar decompression in adults with achondroplasia

Most patients with achondroplasia experience neurologic symptoms within their lifetime. Lumbar stenosis is the major cause of such symptoms, and lumbar decompression has long been the treatment of choice. The most frequent complications of lumbar decompression in the general population are dural tears, but the incidence among patients with achondroplasia remains largely unknown. To determine the incidence and associated complications of intraoperative dural tears during decompression in patients with achondroplasia, we evaluated the outcomes of all patients with achondroplasia who underwent primary lumbar decompressions (80 patients) and subsequent revisions (22 patients, 23 procedures) at our hospital between 1970 and 2005. Of the 80 patients who underwent primary decompression, 31 (38.8%) experienced at least 1 dural tear, and of 23 revision procedures, 8 (34.8%) resulted in at least 1 dural tear. In addition, patients with dural tears were more likely to have surgical-site infections than those who did not have dural tears. Finally, we found that the incidence of dural tears in patients with achondroplasia has decreased over time at our hospital. Our results should alert surgical teams to the potential for complications when preparing for the surgical care of patients with achondroplasia.