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Pain and Spine Medicine

Management of Multilevel Spinal Compression in Achondroplasia: A Case Report

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Kiosk 4

    Primary Author(s)

  • MH

    Myrna Hanna, DO

    Resident
    Montefiore Medical Center/Albert Einstein College of Medicine PM&R Program
    Bronx, New York

    • Poster Presenter(s)

  • Min Ju Kim, DO

    Resident
    Montefiore Medical Center/Albert Einstein College of Medicine PM&R Program
    Bronx, New York

    • Co-Author(s)

  • Giorgina Giampaolo, MD

    Resident
    Montefiore Medical Center/Albert Einstein College of Medicine PM&R Program
    Bronx, New York

  • Aye Mon Win, DO (she/her/hers)

    Medical Director, Inpatient Rehabilitation
    Montefiore Medical Center, New York

Disclosure(s):
Myrna Hanna, DO: No financial relationships to disclose
Giorgina Giampaolo, MD: No financial relationships to disclose
Aye Mon Win, DO: No financial relationships to disclose
Case Diagnosis: A 35-year-old male with multilevel cord compression

Case Description or Program Description: A 35-year-old male with achondroplasia presented with left lower extremity weakness, paresthesias, and gait difficulty refractory to conservative treatments. He reported chronic back pain and prior thoracic spine surgery for a T12 kyphotic deformity, with imbalance and frequent falls since childhood. Physical examination showed 2/5 strength in the extensor hallucis longus, plantarflexion, and dorsiflexion. MRI revealed cervical stenosis with myelomalacia at C3-5 and C7-T1, cord compression at T4-5, T9-10, T12-L1, and cauda equina compression from L2-S1. There was no other limb involvement, upper motor neuron signs, or bowel/bladder changes indicating symptomatic myelopathy. The patient underwent posterior cervical laminectomy at C3-7 and was admitted to inpatient rehabilitation. He showed significant improvement in strength and function, progressing to ambulation with a rolling walker. On discharge, his strength was 4/5 in the left lower extremity.

Setting: Inpatient Rehabilitation Facility

Assessment/Results: After three weeks of rehabilitation, the patient demonstrated significant improvement and was discharged with continued therapy. At his one-month follow-up, he had achieved a modified independent level of function using a straight cane, however, with persistent weakness.

Discussion (relevance): Achondroplasia, resulting from mutations in the FGFR3 gene, causes short stature and neurological complications, including cervical myelomalacia. Anatomical features such as short pedicles contribute to spinal stenosis and cervical compression. This patient had multilevel cervical myelomalacia, thoracic, and cauda equina compression but presented with lumbar radiculopathy. Given his presentation, the improvement in strength after rehabilitation is more likely due to the rehabilitation itself than the cervical laminectomy. However, thoracolumbar surgery is planned to address his symptoms further.

Conclusions: This case emphasizes the importance of early intervention and a multidisciplinary approach in managing neurological complications of achondroplasia. Surgery and rehabilitation greatly enhanced the patient’s strength and function. In addition, timely care—coupled with correlating MRI findings to clinical symptoms—is crucial in evaluating treatment options.