Case reports:
Case 1: A 63-year-old man from a rural region where people
regularly consume well water with fluoride dust, presented to our
department with quadriplegia and urinary incontinence. His symptoms
started insidiously with pain in the joints and the back. Then, he
started having weakness of upper and lower limbs with difficulty in
walking. Clinical examination revealed stiffness of the neck and back, a
spastic quadriplegia with stretch reflex hyperactivity and presence of
Babinski sign. Blood tests were normal. On X-rays of cervical and
thoracic spine, a diffuse osteocondensation was found. A cervical CT
revealed a spinal cord compression by exuberant osteophytosis and
ossification of longitudinal ligament at cervical levels (C4-C7). MRI
revealed signs of myelopathy with high signal intensity T2 of the spinal
cord (Fig.1) . Only symptoms treatment (analgesic and
non-steroidal anti-inflammatory drugs) was proposed for this patient.
Surgical decompression was discussed but not performed because of the
high-risk-surgery.
Case 2: A 70-year-old man from south of Tunisia, presented to
our department with 1-year history of weakness of upper and lower limbs
with urinary incontinence. Clinical examination revealed a severe
spastic quadriparesis, a pyramidal syndrome with a sensory level (T4)
accompanied by back pain with limited spinal mobility. In addition,
brownish mottling was observed on his teeth. Plain X-rays of cervical
and thoracic spine and computed tomography (CT) revealed diffuse
osteosclerosis with exuberant osteophytosis and ossification of the
posterior longitudinal ligament. In addition, an ossification of
interosseous membranes on forearms and legs-X-rays was found(Fig.2) . Biological tests were normal. Magnetic resonance
imaging (MRI) revealed a spinal cord compression due to ossification of
the ligamentum flavum and posterior longitudinal ligament at the
cervical level (C4-C6) with high signal intensity (T2) of the spinal
cord.
Case 3: A 70-year-old-man from a rural area (Sidi Bouzid,
Tunisia) presented to our department with 4-months history of chronic
weakness of lower limbs with urinary incontinence accompanied by neck
and lower back pain. On examination, a spastic quadriparesis with a
pyramidal syndrome and Babinski sign were revealed. X-rays showed
increased bone density with calcification of ligaments, muscular
attachment (on pelvis and spine) and interosseous membranes. MRI
revealed a spinal cord compression due to ossification of posterior
longitudinal ligament at the cervical level. Decompressive laminectomy
was proposed for this patient.