title: Thoracic myelopathy with alkaptonuria.
abstract: METHODS
  A case of thoracic myelopathy with alkaptonuria (ochronotic spondyloarthropathy) is presented.
  
  
  OBJECTIVE
  To present and review the first reported case of an alkaptonuric patient with concomitant thoracic myelopathy.
  
  
  BACKGROUND
  Alkaptonuria, a rare hereditary metabolic disease, is characterized by accumulation of homogentistic acid, ochronosis, and destruction of connective tissue resulting in degenerative spondylosis and arthritis. Despite the high incidence of intervertebral disc diseases among patients with alkaptonuria, neurologic symptoms caused by spinal disease are rare. Thoracic myelopathy in a patient with alkaptonuria has not been previously reported.
  
  
  METHODS
  The clinical course, radiologic features, pathology, and treatment outcome of an alkaptonuria patient with thoracic myelopathy was documented.
  
  
  RESULTS
  Myelopathy of the patient was caused by rupture of a thoracic intervertebral disc. The neurologic symptoms of the patient were markedly improved after surgery.
  
  
  CONCLUSIONS
  We have reported for the first time, that an alkaptonuria patient showed thoracic myelopathy caused by rupture of a thoracic intervertebral disc. Decompression followed by the instrumented fusion of the thoracic spine was effective for improving the neurologic symptoms.
authors.affiliation: Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Mie, Japan. k_akeda@clin.medic.mie-u.ac.jp
authors.forename: Koji
authors.initials: K
authors.lastname: Akeda
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kasai
authors.forename: Eiji
authors.initials: E
authors.lastname: Kawakita
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Matsumura
authors.forename: Toshibumi
authors.initials: T
authors.lastname: Kono
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Murata
authors.forename: Atsumasa
authors.initials: A
authors.lastname: Uchida
mesh_terms: D000368:Aged; D000474:Alkaptonuria / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D019299:Decompression, Surgical; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology* / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009794:Ochronosis / Q000209:etiology / Q000473:pathology; D013116:Spinal Cord / Q000473:pathology / Q000601:surgery; D013118:Spinal Cord Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000473:pathology*; D016896:Treatment Outcome