Impact of posterior atlanto-occipital membrane resection on the durability of foramen magnum decompression in pediatric patients with achondroplasia
DOI:
https://doi.org/10.59156/revista.v40i01.794Keywords:
Acondroplasia, Descompresión del foramen magno, Resección de la membrana atlantooccipital posterior, Reintervención quirúrgicaAbstract
Background: foramen magnum decompression (FMD) in patients with achondroplasia may be associated with progressive restenosis and the need for reoperation. Posterior atlanto-occipital membrane resection (PAOMR) is performed in some centers with the aim of increasing the suboccipital space, although its independent impact on decompression durability has not been evaluated in isolation.
Objectives: to assess the association between PAOMR and event-free survival following FMD in pediatric patients with achondroplasia.
Methods: this retrospective single-center study included 33 patients younger than 18 years who underwent primary FMD between 2013 and 2024. Sixteen patients (48%) underwent PAOMR. The primary outcome was event-free survival (EFS), defined as significant reossification (>50% of the canal) or reoperation due to persistent cervicomedullary compression. Kaplan–Meier curves were estimated and compared using the log-rank test. An age-adjusted Cox model (≥24 months) was performed, with internal validation using bootstrap resampling.
Results: thirteen events (39.4%) were recorded. Five-year EFS was 100% in the PAOMR group (no events before 60 months) versus 57.8% in the non-PAOMR group (95% CI 31.1-77.3; log-rank p=0.0018). In the adjusted Cox model, PAOMR was associated with a significant reduction in the risk of an event (HR 0.060; 95% CI 0.0067-0.531; p=0.0115). No complications attributable to PAOMR were observed.
Conclusion: PAOMR was associated with greater durability of FMD without an increase in morbidity. These findings support its systematic incorporation as a technical adjunct in specialized centers, although prospective validation is required.
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