Abstract

Fluorosis is a disease caused by an excess of fluoride in the water, it is endemic in many parts of India,Afghanistan; Irak, Iran and North Africa. Fluoride is retained in the bones and induces hardening of all the bones, including the spine, hypertrophy of the joints and bones is seen, similar to osteoarthritis. Sclerosis or ossification of the posterior longitudinal ligament can occur, with resulting myelopathy and radiculopathy from root compression.

We report an uncommon complication in dorsal skeletal fluorosis. It is a dorsal spondylolisthesis at D4-D6 level complicated by spinal cord compression described in a 50-year-old woman living in an endemic area for fluorosis (a rural area with an excess of fluoride in the water). This patient showed clinical symptoms of spinal cord compression evolving for 2 years consisting of:

– walking troubles with a pyramidal syndrome of the inferior members
– a sensitive level clair on D6 without sphincterian troubles

The magnetic resonance imaging showed a block of bony compression opposite D4-D6, depicting ossified spinal ligaments, also the spinal cord is grossly compressed. The disease is confirmed with urinary fluoride levels and the bone biopsy was suggestive of skeletal fluorosis.

Good improvement was observed after surgical decompression.

In conclusion, fluorosis was described as a consequence of endemic exposure to high fluoride content in soil and natural ground water in North Africa. Fluorotic myelopathy was due to bone excrescences mainly affecting the spine.

The diagnosis of fluorosis must be ruled out in patients from endemic areas who seem to have osteoarthritis. Some people may have fluoride toxicity because they receive fluoride in their diets in addition to that in drinking water. There have been reports that fluoridation has no benefit in
reducing dental decay, but this has not been widely accepted. However, lower fluoridation levels would be preferred.

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