Spinal Fluorosis is A Progressive Disabling Metabolic Bone Disease

Fluorosis is a crippling disease world over due to deposition of fluoride in the hard and soft tissues of body.

Prevalence:

Fluorosis is endemic in 25 countries. Like Syria, Jordan Sudan, Kenya Iran Iraq Afhghatistan Turkey and India. In India 15 million population in 20 states and 230 districts are affected. 60 million are disabled with 1/10 having neurological manifestations. Indian states like Rajasthan, Gujarat and Andhra Pradesh are worst affected, whereas Tamil Nadu, Bengal and Bihar are least affected.

According to WHO the desired limit of fluoride Is 1PPM parts per million.

Causes:

1. Increased fluoride content more than 6PPM in water

2. temperatures of115-116 fahrenheit.

3. Hard labour during summers

4. Poor nutrition with low calories and vitamin C

5. Kidney disease

6. Food products, toothpaste, mouth wash with high fluoride content

7. Industrial pollution.

8. Trace elements—strontium, silica, uranium, calcium, magnesium pollution of water and food .

Neurological Manifestations:

1. Radiculopathy : Severe disabling pain in limbs

2. Myelopathy: Mechanical compression of spinal cord with tightness and weakness of limbs

3. Radiculopathy+ Myelopathy

4. Sclerosed Vertebrae

5. Ossified Ligaments

Direct neurotoxicity of fluoride is not recorded. However vascular compromise with ischemic injury of spinal cord and roots are described .

Symptoms:

first ever report of neurological manifestations of fluorosis was from Prakasam district of Andhra Pradesh in 1937, but the fluoride levels in water were not high , high temperatures and hard labour during summers are related.

Fluorosis endemic areas are symptom free for about 30 years. The symptoms are mainly restricted to the four limbs ,higher cerebral functions ,cranial nerve palsie are rare.

Involvement:

Cervical spine is affected earlier than dorsal . Lumbar spine exhibits first changes but compression requiring surgery is unusual. Minor spinal trauma can precipitate Significant deficits.

Investigations:

1. Urine fluoride levels in 24 hour sample collection. Normal(0.1-2 PPM).

2. Plain X-ray

of forearm.

3. Radioisotope bone scan.

4. MRI of spine.

5. Serum fluoride levels.

Surgery could be risky and time consuming

1 Difficult to intubate.

2 Prone position.

3.Ventilator requirement.

4. Electric drills improved the ease & safety.

Conclusions:

1 Defluoridation of drinking water.

2. Lime+ alum treatment of water is practical and simple solution.

3. Screening of industrial workers urine fluoride levels .

4. Diagnose early.

5. Promotion of calcium nutrition .

6. Improve the living standards in endemic zones.

7. Educating harmful effects of fluoride conaminated food & water consumption.

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