OCHRONOTIC SPINE WITH LUMBAR CANAL STENOSIS AND INSTABILITY - A CASE REPORT

Abstract

Spinal involvement in alkaptonuria is
common. Alkaptonuria with canal stenosis
and instability has however not been
reported. we wish to report one such patient.
Lumbar canal stenosis with instability
following ochronosis is a disorder with
limited reports in the literature. This case
is being presented for the surgical management
of one of the complications of
alkaptonuria- ochronotic spine. A 32 year
old male was referred from the Rheumatology
department with a diagnosis of Alkaptonuria.
The patient had severe back
pain and was unable to stand or sit or
walk for some distance or lie down comfortably
in bed. X-ray of the Lumbar
spine revealed loss of lumbar lordosis,
gross narrowing of the disc spaces,
dense calcification of all the discs and
advanced osteoporotic and degenerative
changes. Patient also demonstrated instability
in the lumbar spine.
These findings confirmed that the patient
was having an ochronotic spine. MRI-LS
spine showed severe canal stenosis at
multiple levels. Patient was taken up for
decompression surgery to relieve his
symptoms. In addition an instrumented
posterolateral fusion was done to address
the instability. The spine was so osteoporotic
that pedicle screws had poor purchase
in the vertebra. To overcome this
problem, a spino-pelvic fixation was done
on the right side. At follow up after 12
months, patient is comfortable being able
to sit or stand comfortably and walk for
long distances. However he still has pain in
the lower back due to osteoporosis. He is
on treatment for severe osteoporosis.