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Compressive myelopathy in fluorosis: MRI
R K Gupta1, P Agarwal, S Kumar
1Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Abstract:
We examined four patients with fluorosis, presenting with compressive myelopathy, by MRI, using spin-echo and fast low-angle shot sequences. Cord compression due to ossification of the posterior longitudinal ligament (PLL) and ligamentum flavum (LF) was demonstrated in one and ossification of only the LF in one. Marrow signal was observed in the PLL and LF in all the patients on all pulse sequences. In patients with compressive myelopathy secondary to ossification of PLL and/or LF, fluorosis should be considered as a possible cause, especially in endemic regions.
Insights
Fluorosis can cause spinal cord compression due to ossification of spinal ligaments. MRI revealed ligament ossification in four patients with compressive myelopathy, suggesting fluorosis as a potential cause in endemic areas.
Area of Science:
- Neurology
- Radiology
- Orthopedics
Background:
- Fluorosis is a public health concern, particularly in endemic regions.
- Compressive myelopathy can result from various spinal pathologies.
- Ossification of spinal ligaments, including the posterior longitudinal ligament (PLL) and ligamentum flavum (LF), can lead to cord compression.
Purpose of the Study:
- To investigate the role of fluorosis in compressive myelopathy.
- To evaluate MRI findings in patients with fluorosis-associated myelopathy.
- To highlight fluorosis as a potential cause of spinal ligament ossification and cord compression.
Main Methods:
- Retrospective analysis of four patients with fluorosis and compressive myelopathy.
- Magnetic Resonance Imaging (MRI) using spin-echo and fast low-angle shot sequences.
- Assessment of spinal cord and ligamentous structures for ossification and signal changes.
Main Results:
- MRI demonstrated cord compression secondary to ossification of the PLL and LF in one patient.
- Ossification of the LF alone was observed in another patient.
- Abnormal marrow signal within the PLL and LF was present in all four patients across all MRI sequences.
Conclusions:
- Fluorosis should be considered in the differential diagnosis of compressive myelopathy, especially in endemic areas.
- MRI findings of PLL and/or LF ossification in the context of myelopathy warrant consideration of fluorosis.
- Early recognition of fluorosis-related spinal changes is crucial for appropriate management.