Pneumomediastinum, subcutaneous emphysema, and tracheal tear in the early postoperative period of spinal surgery in a paraplegic achondroplastic dwarf.

[achondroplasia]

Achondroplasia was first described in 1878 and is the most common form of human skeletal dysplasia . Spinal manifestations include thoracolumbar kyphosis , foramen magnum , and spinal stenosis . Progressive kyphosis can result in spinal cord compression and paraplegia due to the reduced size of spinal canal . The deficits are typically progressive , presenting as an insidious onset of paresthesia , followed by the inability to walk and then by urinary incontinence . Paraplegia can be the result of direct pressure on the cord by bone or the injury to the anterior spinal vessels by a protruding bone . Surgical treatment consists of posterior instrumentation , fusion with total wide laminectomy at stenosis levels , and anterior interbody support . Pedicle screws are preferred for spinal instrumentation because wires and hooks may induce spinal cord injury due to the narrow spinal canal . Pedicle lengths are significantly shorter , and 20 -25 â€‰mm long screws are appropriate for lower thoracic and lumbar pedicles in adult achondroplastic There is no information about the appropriate length of screws for the upper thoracic pedicles . Tracheal injury due to inappropriate pedicle screw length is a rare complication . We report an extremely rare case of tracheal tear due to posterior instrumentation and its management in the early postoperative period .