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We report a case of a 35-year-old man with achondroplasia who previously had thoracolumbar decompressive laminectomies, who developed recurrence of spinal stenosis at the thoracolumbar junction. The patient underwent standard repeat thoracolumbar decompression, removal of a disc, and spinal fusion with instrumentation in the prone position. Postoperatively the patient was confused. Computed tomography (CT) revealed hemorrhages in both cerebellar hemispheres with surrounding edema and mild mass effect. These were interpreted as venous hemorrhages. Conservative therapy was successful. This is the first case report of perioperative venous intracranial hemorrhage in the context of spinal surgery for achondroplasia. Distinctive anatomic characteristics of achondroplasia, combined with several potentially modifiable aspects of his management, may have predisposed the patient to this complication.

The characteristics of spinal restenosis in achondroplasia and its treatment are evaluated in this study. Radiologic and surgical findings were correlated to establish the causes of achondroplastic spinal restenosis and the benefits of its therapy. Eight patients (five men, three women) with spinal restenotic complications of achondroplasia were studied. The most common neurological sign of recurrent stenosis was impaired motor function. The mean interval between the most recent surgeries was 8.2 years (9.5 years for surgeries at the same levels). The most common causes of recurrent stenosis were facet hypertrophy and disk disease. The complications were a dural tear and cerebellar hemorrhage in one patient and transient neurological deterioration in another. One patient died after operation. Restenosis can occur many years after original decompression in the achondroplastic spine, and repeated operation can successfully lessen pain and neurological symptoms in most patients.

A rare elbow fracture pattern involving the radial neck, olecranon, and medial epicondyle is described in a pediatric patient. Medial and lateral fixation was necessary to control the three planes of instability. Commonly, radial neck fractures with an associated elbow injury (olecranon or medial epicondyle) are stable with lateral fixation alone.