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

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.