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European Spine Journal

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01-10-2019 | Pseudarthrosis | Grand Rounds

Management of a pseudarthrosis with sagittal malalignment in a patient with ochronotic spondyloarthropathy

Authors: Wael Alkasem, Louis Boissiere, Ibrahim Obeid, Anouar Bourghli

Published in: European Spine Journal | Issue 10/2019

Abstract

Purpose

Ochronotic spondyloarthropathy is an uncommon disease, and its association to sagittal malalignment in the context of a pseudarthrosis has never been described.

Methods

We present the case of a 56-year-old female, who underwent previously L4L5 laminectomy for central canal stenosis and started later on to complain of progressively severe low back pain with a significant forward imbalance while walking. X-rays showed non-compensated sagittal malalignment due to thoracolumbar kyphosis, CT scan revealed multilevel central intradiscal calcifications with important vacuum disc at L4L5, and MRI showed T1 and T2 hypointensity signal at the same level with bone marrow oedema. Alkaptonuric ochronosis was suspected and confirmed by the presence of homogentisic acid in the urine, and the diagnosis of L4L5 pseudarthrosis with associated severe sagittal malalignment in the context of ochronotic spondyloarthropathy was established.

Results

The patient underwent surgery with a posterior-only approach with a long-segment pedicle screw construct from T10 to the pelvis with a 360° fusion with a cage at L4L5. Samples taken from the disc and ligaments confirmed the diagnosis of ochronotic spondyloarthropathy macroscopically and microscopically. She could walk on day 2 with a satisfactory clinical and radiological result at 2 years.

Conclusion

This is the first case in the literature to describe a post-laminectomy pseudarthrosis leading to a significant sagittal malalignment in a patient with ochronotic spondyloarthropathy. Management of such a case is challenging as the spine is partially ankylosed; therefore, a long construct is advisable to avoid ankylosing disorders related complications.

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Title: Management of a pseudarthrosis with sagittal malalignment in a patient with ochronotic spondyloarthropathy
Authors: Wael Alkasem
Louis Boissiere
Ibrahim Obeid
Anouar Bourghli
Publication date: 01-10-2019
Publisher: Springer Berlin Heidelberg
Keywords: Pseudarthrosis
Laminectomy
Spondyloarthropathy
Published in: European Spine Journal / Issue 10/2019
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-019-06020-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Management of a pseudarthrosis with sagittal malalignment in a patient with ochronotic spondyloarthropathy

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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