Abstract
Introduction Sequestered disc fragments in the achondroplastic dwarf are rare. They should be removed by an anterior approach because:
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access to remove the fragment posteriorly is severely compromised by the condition.
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The commonest spinal deformity requiring surgery in the achondroplastic is thoracolumbar kyphosis, the tendency to which is increased by a posterior approach.
Method The case is of a 30 year old achondroplastic dwarf with spontaneous sudden onset of myelopathy over three myotomes. An MRI scan revealed an L1-2 large disc herniation compressing the thecal sac in an already small canal.
Results The spinal decompression resulted in recovery from the paresis without creating the instability associated with a wide posterior exposure.
Discussion The thoraco-abdominal approach involves incision along the line of the rib two levels above the most proximal vertebral body to be visualized. The external oblique and internal oblique are incised in the line of the rib. The diaphragm is taken down from the costal cartilage to the crus posteriorly allowing access to the upper lumbar spine. The segmental vessels are identified and subperiosteal dissection carried out. The disc is excised and the adjacent posterolateral vertebral body extending toward the segmental vessels. The neural elements are decompressed and the spine is stabilized using the rib strut as graft in the space created by the vertebral resection with morselized graft into the intervertebral disc space.
The abstracts were prepared by Assoc Prof Bruce McPhee. Correspondence should be addressed to him at the Division of Orthopaedics, The University of Queensland, Clinical Sciences Building, Royal Brisbane Hospital, Herston, Brisbane, 4029, Australia.
