Fluorosis Masquerading as Compressive Myelopathy

Abstract

A 60-year-old woman from Cuddalore presented with restricted neck movements, progressive difficulty in walking, and lower limb weakness, leading to bed confinement. Clinical examination revealed spastic paraparesis, brisk reflexes, and sensory deficits below the hips. Laboratory investigations indicated renal insufficiency and elevated urine fluoride levels. Imaging demonstrated calcifications of sacroiliac, sacrospinous ligaments, interosseous membrane, and posterior longitudinal ligament, with osteosclerosis and osteoporosis. Differential diagnoses included Ankylosing Spondylitis and Diffuse Idiopathic Skeletal Hyperostosis. However, the unique pattern of ligament calcification and elevated fluoride levels supported a diagnosis of fluorosis. This case underscores the importance of considering fluorosis in patients from endemic areas with spastic paraparesis and characteristic radiological findings. Posterior decompression via laminectomy was performed, emphasizing the need for awareness of fluorosis as a potential cause of cervical compressive myelopathy.

Keywords

• fluorosis
• posterior longitudinal ligament calcification
• interosseous membrane calcification
• osteosclerosis
• diffuse idiopathic skeletal hyperostosis (dish)