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Achondroplasia Foramen Magnum Score: screening infants for stenosis
  1. Moira S Cheung1,
  2. Melita Irving2,
  3. Alessandra Cocca1,
  4. Rui Santos3,
  5. Meera Shaunak1,
  6. Harry Dougherty1,
  7. Ata Siddiqui4,
  8. Paul Gringras5,
  9. Dominic Thompson6
  1. 1Department of Paediatric Endocrinology, Evelina London Children's Hospital, London, UK
  2. 2Department of Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
  3. 3Department of Paediatric Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
  4. 4Department of Neuroradiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
  5. 5Department of Sleep and Neurodisability, Evelina London Children's Hospital, London, UK
  6. 6Department of Paediatric Neurosurgery, Great Ormond Street Hospital, London, UK
  1. Correspondence to Dr Moira S Cheung, Department of Paediatric Endocrinology, Evelina London Children's Hospital, London SE1 7EH, UK; Moira.Cheung{at}


Background Achondroplasia is associated with foramen magnum stenosis (FMS) and significant risk of morbidity and sudden death in infants. A sensitive and reliable method of detecting infants who require decompressive surgery is required. This study aims to describe the incidence and severity of FMS in an unselected, sequential series of infants using a novel MRI score and retrospectively correlate severity with clinical examination and cardiorespiratory sleep (CRS) studies.

Methods The Achondroplasia Foramen Magnum Score (AFMS) was developed and scores were retrospectively correlated with clinical and CRS data over a 3-year period.

Results Of 36 infants (M:F, 18:18), 2 (5.6%) did not have FMS (AFMS0); 13 (36.1%) had FMS with preservation of the cerebrospinal fluid (CSF) spaces (AFMS1); 3 (8.3%) had FMS with loss of the CSF space but no spinal cord distortion (AFMS2); 13 (36.1%) had FMS with flattening of the cervical cord without signal change (AFMS3); and 5 (13.9%) had FMS resulting in cervical cord signal change (AFMS4). Mean Total Apnea and Hypopnea Index (TAHI) for AFMS0–4 was 3.4, 6.41, 2.97, 10.5 and 25.8, respectively. Severe TAHI had a specificity of 89% but only a 59% sensitivity for AFMS3–4. Neurological examination was normal in 34/36 (94%) patients. Overall, 9/36 (25%) infants required neurosurgery with minimal surgical complications.

Conclusions Clinical examination and CRS have a low sensitivity for predicting the effects of foramen stenosis on the spinal cord. Routine screening with MRI using AFMS can aid in detecting early spinal cord changes and has the potential to reduce infant morbidity and mortality.

  • neurosurgery
  • neonatology
  • genetics
  • pathology

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  • Contributors MSC conceptualised and designed the study, coordinated and supervised the data collection, and drafted the initial manuscript. DT designed the AFMS scoring system. MI provided expertise in achondroplasia. RS provided the images and reviewed the radiology. AS reviewed the radiology. PG provided expertise on the background sleep studies. AC, HD and MS designed the data collection instruments, collected the data and carried out the initial analyses. All authors reviewed and revised the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Research Ethics Committee approval was waived, and parental consent was not required as patient details were not identifiable. The study was registered with our local service evaluation department.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The data are in the form of deidentified participant data. These are available on request.