Management of Acquired Compressive Myelopathy due to Spinal Fluorosis

Abstract

Background:Fluorosis is an endemic disease of India which causes compressive cervical and/or dorsal myelopathy. This study aims to evaluate the role of surgical management in the crippling fluorosis along with evaluation of radiological imaging as screening/diagnosing tool for the disease.Materials and Methods:This is a prospective cohort study of 33 patients operated at tertiary care center having nontraumatic involvement of spinal cord affecting neurology with history, clinical and radiological features (Ossified Posterior Longitudinal Ligament-, Ossified Ligamentum flavum) suggesting fluorosis as the cause of compression. Outcomes were measured in terms of improvement in Nurick grading, Rankins scale, spasticity, Oswestry Disability Index, modified Japanese Orthopaedic Association scores.Results:Spinal fluorosis is a male predominant disease affecting the elderly after years of fluorine intake. Cervical and/or dorsal spine are predominantly involved at multiple levels (>=2). Diagnosis of the disease poses difficulty due to lack of established laboratory parameters with high sensitivity, availability, and lack of awareness among surgeons. Skeletal survey alone has >90% sensitivity for diagnosing the disease. Once evaluated properly, decompression at correctly identified levels invariably improves the spasticity and quality of life immediately post-surgery. At final followup, there was on average improvement of 2 scales in nurick grade, rankins scale and ashworth grading whereas average improvement in ODI, mJOA and dorsal specific mJOA were 52%, 3.17 points and 2.7 points respectively. However, preoperative counselling for “apparent neurological deterioration” in immediate postoperative period is very important. Complications like infection and dural tear have to be prevented with special surgical tactics.Conclusion:Skeletal survey along with computed tomography and magnetic resonance imaging is cost-effective modality for the screening/diagnosis for fluorosis. Once developed, surgery, either curative or palliative, is the best treatment at crippling stage of the disease.

Skeletal Fluorosis: A Case of Inhalant Abuse Leading to a Diagnosis of Colon Cancer

“… 1 The primary imaging modality in our patient was a skeletal survey which has been reported to have over 90% sensitivity in diagnosing the disease. 22 In addition, a dual-energy X-ray absorptiometry has been known to reveal osteosclerosis of the lumbar spine and femur in patients with skeletal fluorosis. 23 Furthermore, skeletal scintigraphy was performed for evaluation of metastatic disease and revealed numerous foci of uptake in the axial and appendicular skeleton.…”

“… 1 Finally, surgical intervention such as decompressive laminectomy or excision of skeletal masses may be employed to help prevent complications and morbidity from the disease. 22 , 25 , 26 Once these measures are taken, improvement in bone mineral density has been observed, but this process can take years. 27 , 28 …”

“…1 Finally, surgical intervention such as decompressive laminectomy or excision of skeletal masses may be employed to help prevent complications and morbidity from the disease. 22,25,26 Once these measures are taken, improvement in bone mineral density has been observed, but this process can take years. 27,28 Last, while treating the patient, clinicians would need to be concerned about nonskeletal complications and risks that can arise from fluorosis.…”

Skeletal Fluorosis With Thoracic Myelopathy: A Report of 2 Cases

“…The oscillating motion, much like a ''plaster cutter'' ensures accurate dissection of bone and calcified soft tissue with minimal risk to the dura and spinal cord. We used the ''floating island technique,'' 17 wherein 13 3. Osteoblastoma 14 4.…”