Multilevel Laminectomy for Lumbar Spinal Stenosis With Low Back Pain in Achondroplasia: A Case Report.

BACKGROUND Achondroplasia is an autosomal dominant skeletal dysplasia and the most common genetic cause of dwarfism, characterized by shortened pedicles, thickened laminae, and reduced interpedicular distances that lead to congenital narrowing of the spinal canal. These anatomical abnormalities frequently result in lumbar spinal stenosis (LSS) requiring surgical management. Surgical treatment typically involves decompression of neural elements, with or without fusion, to restore canal patency and prevent postoperative deformity. However, adjusting the surgical approach to the unique anatomical constraints of achondroplasia remains critical for optimizing clinical outcomes. CASE REPORT We present a rare case of a 55-year-old woman with achondroplasia who presented with a 5-year history of progressively worsening low back pain, bilateral foot drop, and neurogenic claudication after walking short distances. Magnetic resonance imaging (MRI) demonstrated critical lumbar spinal stenosis at L2-L3, L3-L4, and L4-L5. She underwent multilevel laminectomy under general anesthesia with intraoperative fluoroscopic guidance and high magnification. Postoperatively, she was mobilized within 3 hours and discharged the same day without complications. At 4-week follow-up, the muscle strength of the anterior tibialis and quadriceps had improved to 4/5 on the MRC scale, patellar reflexes were normalized, and lower-limb sensation showed marked recovery. CONCLUSIONS This case highlights the importance of intraoperative precision and an appropriate surgical approach in managing lumbar spinal stenosis associated with achondroplasia. Decision-making, detailed preoperative planning with assessment of imaginary findings, intraoperative use of microsurgical techniques, and postoperative care are important in minimizing complications and optimizing clinical outcomes.