Neglected alkaptonuric patient presented with low back pain and radiculopathy: A case report

Background: Alkaptonuria (AKU) is a rare hereditary disorder in which excess homogentisic acid (HGA) deposits in connective tissues (ochronosis). Here, we report the unusual presentation of a lumbar disc herniation occurring in a patient with AKU warranting surgical intervention. Case Description: A 28-year-old male presented with 1 year of low back pain. The lumbar magnetic resonance imaging showed an extruded disc at the L4-L5 level accompanied extensive disc space narrowing and osteophyte formation. At surgery, the interspinous ligaments, facet joints, and disc herniation were black. In addition, the postoperative re-examination revealed a black discoloration of the nasal and ear cartilage. Finally, the diagnosis of AKU was confirmed when the urine specimen was positive for HGA. Conclusion: Rarely, younger patients with AKU who develop excess black deposits of HGA in connective tissues (i.e., ochronosis) may present with lumbar disc herniations and spondylosis.

Pattern of cervical disc changes in patients with non-traumatic neck pain: a review of cervical MRI scan findings

Background: Neck pain is a common global health problem causing significant individual disability and socioeconomic burden on health care facilities. Many factors have been associated with neck pain but the most implicated is the cervical intervertebral disc disease. Magnetic resonance imaging (MRI) scan is considered globally as the most sensitive test for detecting degenerative disc abnormalities associated with neck pain. The objective of this study was to evaluate cervical disc changes on MRI in non-traumatic symptomatic subjects and to accumulate baseline data on the pattern of changes.Methods: A four-years retrospective review of 115 patients (age range 13 to 81 years) who had a cervical MRI scan due to non-traumatic neck and radiating shoulder pain from September 2017 to February 2021 at the Radiology Department of Jos University Teaching Hospital North Central Nigeria. All the patients were scanned using a Single Siemens (Magnetom Concerto) MRI scanner with 0.2T magnetic field strength. Sagittal T1-weighted and T2-weighted fast spin-echo images were acquired, and axial images and contrast-enhanced studies were done only when required.Results: The study included 74 (64.3%) males and 41 (35.7%) females with a mean age of 50.7±13.2 and a modal age group of 41-60 years. The normal intervertebral disc was commonest at C2/C3 followed by C6/C7 level while degenerative disc changes were most commonly seen at C4/C5 followed by C5/C6 level. The majority (93%) of patients had multilevel intervertebral disc changes and the most frequent and severe occurrences of intervertebral disc dehydration, bulge, herniation, and disc space narrowing were noted at C4/C5 (79.1%), C4/C5 (12.2%), C5/C6 (59.1%) and C4/C5 (10.4%) respectively.Conclusions: This study found all patients examined had at least one level of intervertebral disc changes with the majority having multilevel involvement (93%). The most commonly and severely affected level was C4/C5 followed by C5/C6 level. The most frequent and severe occurrences of disc desiccation, bulge, herniation (protrusion/extrusion/sequestration) and disc height reduction were noted at C4/C5 (79.1%), C4/C5 (12.2%), C5/C6 (59.1%) and C4/C5 (10.4%) respectively.

The Association Between Sagittal Plane Alignment and Disc Space Narrowing of Lumbar Spine in Farmers

Objective To investigate whether lumbar lordosis (LL) and lumbar segmental lordosis (LSL) are related to sex, age, low back pain (LBP), and lumbar disc space narrowing (DSN).Methods A total of 569 farmers were recruited. In lateral spine radiograph, LL (L1–L5) and LSL (L1, L2, L3, L4, and L5) were measured using Cobb’s method. The differences in LSL values (ΔLSL) according to the presence or absence of a DSN were calculated as LSLDSN – LSLnoDSN for each DSN level.Results In male, the lateral spine radiograph showed significantly greater L4-LSL and L5-LSL and smaller L1-LSL and L2-LSL compared to female. LLs in the 50–59 and ≥60 years age groups were significantly smaller compared to those in the <50 years age group. In subjects with LBP, LL and L4-LSL were significantly smaller than in those without. The ΔLSLs at the disc level with DSN showed the greatest decrease: L1-ΔLSL (Δ-3.99°), L2-ΔLSL (Δ-3.31°), L3-ΔLSL (Δ-2.87°), L4-ΔLSL (Δ-3.31°), and L5-ΔLSL (Δ-4.44°) in L1/2, L2/3, L3/4, L4/5, and L5/S1 DSN, respectively. Conversely, distant ΔLSLs were inversely increased: L1-LSL (Δ0.75°) with L4/5 DSN and L2-LSL (Δ0.94°) with L5/S1 DSN.Conclusion Sagittal plane alignment was significantly associated with sex, age, LBP, and DSN. LSLs around the levels of DSN were decreased, and there was compensational increase of LSL distant to the DSN to maintain the overall LL.

Relationship between diffuse idiopathic skeletal hyperostosis and fragility vertebral fracture: a prospective study in older men

Objective To analyse the risk of incident vertebral and non-vertebral fracture in men with DISH. Methods In 782 men ages 50–85 years, DISH was diagnosed using Resnick’s criteria. In men followed prospectively for 7.5 years, a radiographic incident vertebral fracture was defined by a decrease of ≥20% or ≥4mm in any vertebral height vs baseline. Self-reported incident non-vertebral fractures were confirmed by medical records. Results Men with DISH had higher BMD at the lumbar spine (P &lt; 0.05), but not at other skeletal sites. After adjustment for confounders including disc space narrowing (DSN) and endplate irregularity, the risk of vertebral fracture was higher in men with DISH vs men without DISH [10/164 (6.1%) vs 16/597 (2.7%), P &lt; 0.05; odds ratio (OR) 2.89 (95% CI 1.15, 7.28), P &lt; 0.05]. DISH and low spine BMD were each associated with a higher vertebral fracture risk. The vertebral fracture risk was higher in men who had both DISH and severe DSN. DISH and endplate irregularities (EIs) were each associated with higher vertebral fracture risk. DISH, DSN and EIs define the intervertebral space dysfunction, which was associated with higher vertebral fracture risk [OR 3.99 (95% CI 1.45, 10.98), P &lt; 0.01]. Intervertebral space dysfunction improved the vertebral fracture prediction (ΔAUC = +0.111, P &lt; 0.05), mainly in men with higher spine BMD (&gt;0.9 g/cm2; ΔAUC = +0.189, P &lt; 0.001). DISH was not associated with the risk of non-vertebral fracture. Conclusion DISH is associated with higher vertebral fracture risk, independently of other risk factors. Assessment of the intervertebral space dysfunction components may improve the vertebral fracture prediction in older men.

FRI0432 INTEREST OF IMAGING IN THE DIAGNOSIS OF INFECTIOUS SPONDYLODISCITIS (ABOUT 113 CASES)

Background:Infectious spondylodiscitis is a diagnosis and therapeutic emergency. Its clinical presentation can be insidious and standard radiographs can be falsely reassuring. This explains the interest of cross-sectional imaging and more particularly magnetic resonance imaging (MRI).Objectives:To analyse the contribution of imaging in the diagnosis of infectious spondylodiscitis.Methods:These are 113 cases of spondylodiscitis collected in a rheumatology department over a period of 20 years [1998-2018]. The diagnosis is made on the basis of clinical, biological, radiological and bacteriological data.Results:Our population was divided into 62 men (54.9%) and 51 women (45.1%) (p = 0.8) with an average age of 55 years [16–86]. Predisposing factors were found in 52.2% of cases: diabetes (23%), neoplasia (2.7%), hepathopathy (5.3%), long-term corticosteroid therapy (1.8), recent surgery (3.5%), history of tuberculosis (2.7%) and consumption of unpasteurized dairy products (28.3%).The approximate time between onset of symptoms and diagnosis ranged from 0.23 to 24 months (median 3 months). Impaired general condition was observed in 81% of the cases and fever in 34.5% of the cases. Radiculalgia was found in 46% of the cases and a neurological deficit was noted in 16% of the cases. Biological inflammatory syndrome was found in 91.2% of the cases.Standard radiographs of the spine were abnormal in 85% of cases, showing disc space narrowing (72%), irregularity of the vertebral plates (35.5%), erosions (13.1%) and para-vertebral spindle (4.7%). CT and spinal MRI were performed respectively in 57.5% and 70.8% of cases and revealed: erosions (46.2%), mirrored geodes (16.9%), para-vertebral abscess (57.5%), epiduritis (71.3%) and spinal compression (26.3%). The lumbar spine was the most affected (55.8%), followed by the dorsal spine (30.1%) and the cervical spine (8.8%). The Infectious spondylodiscitis was multifocal in 24.8% and multi-stage in 12.4% of cases.A disco-vertebral biopsy was performed in 70% of cases and was contributory in 44.3% of cases. The causative organism was tuberculosis in 55.8% of cases, brucellosis in 21.2% of cases and pyogenic germs in 23% of cases.Conclusion:Imaging plays an important role in the diagnosis of spondylodiscitis. MRI is considered the key examination, capable of mapping injuries and detecting potentially serious neurological complications. The importance of imaging the entire spine to detect multifocal forms should also be emphasized.Disclosure of Interests:None declared

FRI0433 HAS THE PROFILE OF INFECTIOUS SPONDYLODISCITIS CHANGED IN 20 YEARS?

Background:Infectious spondylodiscitis represents 2 to 4% of osteoarticular infections. Their incidence is constantly increasing. Early microbiological diagnosis and targeted multidisciplinary management are the main prognostic factors for infectious spondylodiscitis.Objectives:To compare the epidemiological, clinical, biological, radiological, bacteriological profile as well as the management and prognosis of spondylodiscitis over the last 20 years.Methods:Retrospective study including 113 patients hospitalized in our department between 1999 and 2018. The diagnosis was based on clinical, biological, radiological and bacteriological data. Spondylodiscitis were divided into two groups: spondylodiscitis occurring between 1998 and 2008 (1stdecade) and those between 2009 and 2018 (2nddecade).Results:Of the 113 identified patients, 54 (47.8%) occurred between 1998 and 2008, with male predominance in both groups (50.2 and 59.3% respectively; p=0.3). The average age was 55 years (p=0.7). Diabetes was more frequent in the 1stdecade but without a statistically significant difference (p=0.1). On the other hand, consumption of unpasteurized dairy products was more frequent during the 2nddecade (p<0.001) as well as the presence of intercurrent infection (p=0.01).The estimated delay between symptom onset and diagnosis was longer between 1998 and 2008 (5.6 months and 3.2 months respectively, p=0.005). The presence of neurological signs was more frequent between 2009 and 2018 (p=0.001), especially radiculalgia (p=0.02). The sedimentation rate was higher in the 1stdecade (93mm and 72mm respectively, p=0.002).We found no statistically significant difference in the location of spondylodiscitis (p=0.4) and the multifocal involvement (p=0.5).Radiographic signs were significantly more prevalent in the 1stdecade (p=0.002), in particular disc space narrowing (p=0.03) and irregularity of the intervertebral plates (p=0.01). Computed tomography was more often performed during the 1stdecade (p = 0.008), unlike magnetic resonance imaging, performed in 88.1% of cases during the 2nddecade (p <0.001). In contrast, the frequency of para-vertebral abscesses, epiduritis and spinal cord compressions were similar in the two groups (p = 0.6; p = 0.9 and p = 0.3, respectively).Tuberculosis was more frequent in the 1stdecade (p=0.009). Disco-vertebral biopsy was more often performed in the 1stdecade (p=0.04), but its efficiency was similar between the two groups (p=0.1). For pyogenic spondylodiscitis, blood cultures were more often positive in the 2nddecade but without a statistically significant difference (p=0.6). On the other hand, the anatomopathological aspect was more frequently suggestive of a pyogenic germ in the 2nddecade (p=0.04).A surgical procedure was more frequently performed between 2009 and 2018 but with no statistically significant difference (p = 0.2). All patients received antibiotic therapy. A change in treatment was made in 23.7% of cases between 2009 and 2018 (p = 0.01). The prognosis was better during the 1stdecade (p = 0.01). On the other hand, the occurrence of immediate complication during tuberculous spondylodiscitis was more frequent during the 2nddecade (p = 0.03), in particular the toxicity of anti-tuberculosis treatment (p = 0.04).Conclusion:In the last decade, the diagnosis of spondylodiscitis has been made earlier. However, these are more severe forms with an increased frequency of neurological complications, probably due to an increase in the proportion of virulent germs. Moreover, the effectiveness of the bacteriological investigation does not differ between the two periods studied.Disclosure of Interests:None declared

Radiological Changes in the Cervical Spine in Freshman Collegiate Sumo Wrestlers

Background: Sumo has long been a traditional sport in Japan and is rapidly attracting enthusiasts abroad. Sumo wrestling entails a risk of impact to the cervical spine during an initial charge. Few reports are available in the English-language literature regarding radiological changes in the cervical spine in sumo wrestlers. Purpose: To examine radiological changes in the cervical spine in freshmen collegiate sumo wrestlers. Study Design: Case series; Level of evidence, 4. Methods: A total of 53 freshmen sumo wrestlers (age, 18-19 years) who belonged to the Japan Sumo Federation underwent routine radiographic examination of the cervical spine and completed questionnaires on cervical symptoms. Results: Of the 53 wrestlers, 81% showed loss of lordosis, 45% showed osteophyte formation (mainly at C3-C4), 11% showed disc space narrowing (mainly at C5-C6), and 51% showed narrowing of the cervical nerve root foramina (mainly at C3-C4). Fifty-one percent had some cervical symptoms. A correlation was found between deformity of the cervical bodies (such as intervertebral disc ballooning) and cervical symptoms, but no correlation was found between cervical degenerative changes and cervical symptoms. Conclusion: Our data suggest that loss of lordosis, osteophyte formation, and narrowing of the cervical nerve root foramina at C3-C4 were frequently present in freshmen wrestlers and may be due to the axial load incurred prior to their collegiate careers.