Vertebral changes in ochronosis.

Lagier, R; Sitaj, S

doi:10.1136/ard.33.1.86

Cited by 28 publications

(7 citation statements)

References 15 publications

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“…Shortness of the anterior column, stooping, and kyphosis, which are the ultimate result in other ankylosing disorders, are less severe in ochronosis. 6,32,39,51,58 In such circumstances, the clinical picture with regard to the vertebral column is consistent with the pathology manifested with back pain, accompanied with progressive restriction of the spinal movements. Rarely, multilevel degeneration and protrusion may cause spondylosis, resulting in neurogenic claudication in the lumbar region.…”

Section: Discussionmentioning

confidence: 54%

“…The disc spaces are markedly narrowed and the discs are heavily calcified in the periphery, with a wafer-like appearance. 6,32,34,39,40,51 The presence of multiple so-called vacuum discs is another striking feature of spinal ochronosis. 17 However, with progression of the disease, marginal sclerosis of the vertebral bodies accentuated by osteopenia and reactive marginal osteophytosis results in bony bridges.…”

Section: Discussionmentioning

confidence: 99%

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Symptomatic pseudarthrosis in ochronotic spine: case report

Rahimizadeh

Soufiani

Hassani

2017

SPI

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In this study the authors report the first example of spinal pseudarthrosis in a patient with ochronosis, and they describe the application of posterior-only 360° surgery as an alternative approach to combined anterior-posterior surgery in the management of pseudarthrosis of an ankylosed spine, regardless of its etiology. Spinal involvement in ochronosis produces loss of flexibility and ankylosis of thoracic and lumbar segments. Pseudarthrosis is a serious complication of the diseases that present with ankylosis of the spine. However, its occurrence in ochronotic spine has not been reported previously. Evaluation of progressive paraparesis in a 68-year-old man with ochronosis revealed pseudarthrosis at the T11–12 level. Circumferential dural sac decompression, debridement of the disc space, interbody fusion, and screw-rod fixation were all done via a posterior-only approach. Postoperatively the patient exhibited a marked recovery in terms of pain and neurological status. At the 3-month follow-up, he was able to walk independently. Ochronosis should be included in the etiology of pseudarthrosis. With aggravation of back pain and the appearance of neurological deficits in an already stable patient with any ankylosing disease, pseudarthrosis should be suspected. Furthermore, single-stage, 360°, posterior-only surgery may obviate the need for single-stage or staged anterior-posterior surgical intervention in patients with pseudarthrosis of the thoracic and lumbar spine.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Symptomatic pseudarthrosis in ochronotic spine: case report

Rahimizadeh

Soufiani

Hassani

2017

SPI

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“…Generalized osteophytes are common in the elderly. [7][8][9] In the MRI obtained from our patient, we observed L 4-5 extruded disc hernia and significant degenerative changes at thoracolumbar junction ( Figure 2).…”

Section: Discussionmentioning

confidence: 66%

Black colored intervertebral disc; ochronosis: A case report

Ösün¹

2017

Turk J Phys Med Rehab

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Ochronosis is a syndrome caused by the accumulation of homogentisic acid (HGA) in connective tissues. The phenomenon was first described by Rudolf Virchow in 1865. Defective production of homogentisate 1,2-dioxygenase results in the accumulation of HGA, a tyrosine degradation product, in the bloodstream. Large quantities of HGA are excreted daily in the urine, where it oxidizes to benzoquinones, which in turn form the melaninlike polymers that cause the discoloration of urine. Accumulation of HGA and its metabolites in tissues causes ochronosis. [1] The word ochronosis refers to the dark bluish discoloration of connective tissues including the sclera, cornea, auricular cartilage, heart valves, articular cartilage, tendons and ligaments. The embedded pigments also form cross-linkages with pigment depositions in adjacent fibers, stabilizing and reducing the elastic recoil of the fibers. This results in hardening of elastic structures increasing their rigidity and brittleness. Once ruptured, the exposed pigments cause a foreign body reaction and inf lammation. This pigment deposition also invokes deposition of hydroxyapatite, the mineral responsible for bone calcification, further hardening the connective tissue. The condition is most often associated with alkaptonuria but can occur from exogenous administration of phenol complexes like hydroquinone.

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“…We identified 54 articles and four abstracts 2–59 . These covered a total of 339 patients, to which we added one case of our own.…”

Section: Methodsmentioning

confidence: 99%