Fluorotic cervical compressive myelopathy, 20 years after laminectomy: A rare event

Abstract

Background:Spinal cord compression in flourosis is a common complication. These complications are mainly due to compression of the spinal cord by thickening and ossification of posterior longitudinal ligament and ligamentum flavum. Surgical decompression is the treatment of choice for fluorotic spinal cord compression. The recurrence of spinal cord compression after surgical decompression in flourosis is a rare event.Case Description:We are presenting a case of a 63-year-old man who belonged to Kanpur, an endemic fluorosis region in India, with symptoms of cervical cord compression cranial to the operative site, 20 years after laminectomy for cervical fluorotic myelopathy. Urinary and serum fluoride levels were elevated. The patient underwent a skeletal survey: computed tomography and magnetic resonance imaging of the cervical spine showed a postoperative defect of laminectomy, osteosclerosis, osteophyte formation, calcification of the intraosseus membrane in the forearm, thickening and ossification of the posterior longitudinal ligament at C1, thickening and ossification of the residual ligamentum flavum at C1/C2, and dural calcification at the C2 vertebral level and compressive myelopathy. The patient refused surgical decompression and was managed with tizanidine HCl (an antispasticity medicine), a sublingual single night dose, 8 mg for symptomatic relief.Conclusion:The recurrence of spinal cord compression in the fluorotic spine 20 years after laminectomy is a very unusual event and hence the patient should be kept under observation for a long duration. This case report contributes to the literature associated with the management of fluorotic spine.

MRI features of spinal Fluorosis: Results of an endemic community screening

“…about 89% subjects exhibited ligamentum flavum hypertrophy and only one had it ossified. On the other hand, ossification/ calcification of the posterior longitudinal ligament and ligamentum flavum which has been reported in literature as the prominent finding, 9 , 10 , 12 , 15 , 16 was not seen in this study. Rather both the anterior and posterior longitudinal ligaments were thickened.…”

“…Although the radiographic (X-ray) findings of Flourosis are well known, 3 , 9 , 10 - 12 there is limited reporting of MR features of the flourotic spine comprising occasional case reports and two small case series of 5 cases each. MR scan can serve as a tool for early diagnosis and planning proper surgical intervention in the symptomatic patient by visualizing soft tissue and spinal cord changes and associated abnormalities.…”

Management of Acquired Compressive Myelopathy due to Spinal Fluorosis

“…Limitations of our study include lack of in-depth demographic study for levels of drinking water fluoride levels and associated ions in the affected regions. Although midterm outcomes of operative procedure seems promising, long term followup (>5 years) is required to check for instability in the spine, recurrence of the disease 16…”

“…Although midterm outcomes of operative procedure seems promising, long term followup (>5 years) is required to check for instability in the spine, recurrence of the disease. 16 …”

Workshop 1: The 3rd international workshop on information security, theory and practice (ISTP-2013)

“…Because the optimal choice of surgical methods is still contentious, we conducted a systematic review to compare the different surgical methods described in the literature published on this topic to date. The aim of our systematic review was to compare the postoperative symptoms and improvement outcomes for the following two surgical methods: hemilaminectomy and laminectomy [9]- [14]. We hope that the results of this systematic review will help surgeons to choose the best surgical methods for their patients.…”