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    1 OF 19

    Alkaptonuria Severity Score Index Revisited: Analysing the AKUSSI and Its Subcomponent Features.
    JIMD Rep 2018 Apr 14. Epub 2018 Apr 14.
    Royal Liverpool University Hospital, Liverpool, UK.
    Background: Alkaptonuria (AKU) is a rare disorder with no licensed treatment; nitisinone may reduce symptoms and progression. The All Alkaptonuria Severity Score Index (AKUSSI) measures disease severity in clinical, joint and spine domains, with 57 subcomponent feature scores. Our primary aim was to assess tools for validating scores such as the AKUSSI by detecting relationships between features both before and during nitisinone treatment. Read More

    Fatal methemoglobinemia complicating alkaptonuria (ochronosis): a rare presentation.
    Forensic Sci Med Pathol 2018 Mar 23. Epub 2018 Mar 23.
    Forensic Science SA, GPO Box 2790, Adelaide, SA, 5001, Australia.
    A 61-year-old female died in hospital with multiple organ failure 4 weeks following presentation with acute kidney injury, hemolytic anemia and methemoglobinemia. At autopsy, brown to black discoloration of cartilages was observed. Histology revealed brown pigmentation of the hyaline cartilage, with focal full-thickness erosion of the articular hyaline cartilage, characteristic of alkaptonuria (ochronosis). Read More

    Ochronosis of Mitral Valve and Coronary Arteries.
    Ann Thorac Surg 2018 Mar 1. Epub 2018 Mar 1.
    Division of Cardiac Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada. Electronic address:
    Cardiac ochronosis is a rare complication of alkaptonuria, a disorder of tyrosine metabolism characterized by a triad of dark urine, pigmentation of tissues, and ochronotic arthropathies. When present, cardiac ochronosis generally affects the aortic valve resulting in aortic stenosis. More rarely, it may affect the mitral valve and the coronary arteries. Read More

    Calcaneal Avulsion of an Ochronotic Achilles Tendon: A Case Report.
    J Foot Ankle Surg 2018 Jan - Feb;57(1):179-183. Epub 2017 Nov 4.
    Specialist in Pathology, Department of Pathology, Ankara Research and Training Hospital, Ankara, Turkey.
    Alkaptonuria is a hereditary disorder of phenylalanine and tyrosine, with an incidence of approximately 1/200,000 to 1/1,000,000. Ochronosis is the accumulation of homogentisic acid and its metabolites in connective tissues such as the tendons, cartilage, and skin. In the present case study, a 50-year-old male presented with a nontraumatic calcaneal avulsion without a previous diagnosis of ochronosis. Read More

    Arthroscopic diagnosis and treatment of shoulder ochronotic arthropathy - A case report.
    J Clin Orthop Trauma 2017 Aug 5;8(Suppl 1):S80-S83. Epub 2017 Jan 5.
    Orthopaedic Department, Sir Ganga Ram Hospital, Room no 1218-A, Rajendra Nagar, New Delhi, India.
    Alkaptonuria is a rare inherited metabolic disorder, caused by the deficiency of homogentisate 1,2 dioxygenase enzyme. The three major features of alkaptonuria are the presence of homogentisic acid in urine, ochronosis (bluish-black pigmentation in connective tissue) and arthritis of the spine and large joints. We present a 48 years old female presented with pain, restriction of movements of right shoulder. Read More

    Toward a generalized computational workflow for exploiting transient pockets as new targets for small molecule stabilizers: Application to the homogentisate 1,2-dioxygenase mutants at the base of rare disease Alkaptonuria.
    Comput Biol Chem 2017 Oct 25;70:133-141. Epub 2017 Aug 25.
    Department of Biotechnology, Chemistry and Pharmacy, University of Siena, via Aldo Moro 2, 53100 Siena, Italy.
    Alkaptonuria (AKU) is an inborn error of metabolism where mutation of homogentisate 1,2-dioxygenase (HGD) gene leads to a deleterious or misfolded product with subsequent loss of enzymatic degradation of homogentisic acid (HGA) whose accumulation in tissues causes ochronosis and degeneration. There is no licensed therapy for AKU. Many missense mutations have been individuated as responsible for quaternary structure disruption of the native hexameric HGD. Read More

    Severe Aortic Valve Stenosis Due to Alkaptonuric Ochronosis.
    Semin Cardiothorac Vasc Anesth 2017 Dec 14;21(4):364-366. Epub 2017 Jul 14.
    1 Texas Heart Institute, Houston, TX, USA.
    Alkaptonuric ochronosis is a rare cause of aortic valve stenosis. We report the case of a 61-year-old female patient with alkaptonuria who presented to our institute with the clinical picture of severe aortic valve stenosis, which was confirmed by transthoracic echocardiography. On aortotomy, she was noted to have an impressive black discoloration of ascending aorta and the aortic root complex involving the aortic valve leaflets. Read More

    Alkaptonuria: A case report.
    Indian J Ophthalmol 2017 Jun;65(6):518-521
    Department of Ophthalmology, Apollo Institute of Medical Sciences and Research, Jubilee Hills, Hyderabad, Telangana, India.
    Alkaptonuria is a rare inborn error of metabolism with autosomal recessive inheritance with a mutation in homogentisate 1,2-dioxygenase. It results in accumulation of homogentisic acid in connective tissues (ochronosis). Most common ocular manifestations are bluish-black discoloration of the conjunctiva, cornea, and sclera. Read More

    [Anesthetic management of two patients with alkaptonuric ochronosis for total knee arthroplasty].
    Rev Bras Anestesiol 2017 May 20. Epub 2017 May 20.
    Konya Education and Research Hospital, Department of Anesthesiology and Reanimation, Konya, Turkey. Electronic address:
    The current case report describes two cases of alkaptonuric ochronosis for anesthetic management. Alkaptonuria is a rare genetic orphan disease of tyrosine metabolism characterized by an accumulation of homogentisic acid in cartilage and connective tissues. Patients present most commonly for orthopedic joint surgery due to progressive arthropathy that can be misdiagnosed many a times. Read More

    ApreciseKUre: an approach of Precision Medicine in a Rare Disease.
    BMC Med Inform Decis Mak 2017 Apr 14;17(1):42. Epub 2017 Apr 14.
    Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy.
    Background: Alkaptonuria (AKU; OMIM:203500) is a classic Mendelian genetic disorder described by Garrod already in 1902. It causes urine to turn black upon exposure to air and also leads to ochronosis as well as early osteoarthritis. Our objective is the implementation of a Precision Medicine (PM) approach to AKU. Read More

    Histological and Ultrastructural Characterization of Alkaptonuric Tissues.
    Calcif Tissue Int 2017 Jul 7;101(1):50-64. Epub 2017 Mar 7.
    Dipartimento di Biotecnologie, Chimica e Farmacia, Università degli Studi di Siena, Via Aldo Moro 2, 53100, Siena, Italy.
    Alkaptonuria (AKU) is a hereditary disorder that results from altered structure and function of homogentisate 1,2 dioxygenase (HGD). This enzyme, predominantly produced by liver and kidney, is responsible for the breakdown of homogentisic acid (HGA), an intermediate in the tyrosine degradation pathway. A deficient HGD activity causes HGA levels to rise systemically. Read More

    An Unusual Cause of Myelopathy: Ochronotic Spondyloarthropathy With Positive HLA B27.
    Am J Phys Med Rehabil 2017 Nov;96(11):e206-e209
    From the Atatürk Educational and Research Hospital, Physical Medicine and Rehabilitation Clinic (S. Bozkurt); and Physical Medicine and Rehabilitation Department (LA, FGU, NS, SA) and Pathology Department (S. Balci), Yildirim Beyazit University, Ankara, Turkey.
    Ochronosis is a late developing complication of alkaptonuria, a black brownish pigment in the fibrous and cartilaginous tissues. Although most previous studies reported alkaptonuria and back pain due to ochronosis, thoracic myelopathy is an extremely rare complication. In this report, a paraparetic patient who has ochronotic spondiloarthropathy with the presence of HLA B27 antigen is described. Read More

    A new light on Alkaptonuria: A Fourier-transform infrared microscopy (FTIRM) and low energy X-ray fluorescence (LEXRF) microscopy correlative study on a rare disease.
    Biochim Biophys Acta 2017 05 9;1861(5 Pt A):1000-1008. Epub 2017 Feb 9.
    Dipartimento di Biotecnologie Chimica e Farmacia, Università degli Studi di Siena, via Aldo Moro 2, 53100 Siena, Italy. Electronic address:
    Background: Alkaptonuria (AKU) is an ultra-rare disease associated to the lack of an enzyme involved in tyrosine catabolism. This deficiency results in the accumulation of homogentisic acid (HGA) in the form of ochronotic pigment in joint cartilage, leading to a severe arthropathy. Secondary amyloidosis has been also unequivocally assessed as a comorbidity of AKU arthropathy. Read More

    Cartilage biomarkers in the osteoarthropathy of alkaptonuria reveal low turnover and accelerated ageing.
    Rheumatology (Oxford) 2017 Jan 7;56(1):156-164. Epub 2016 Oct 7.
    Department of Medicine, Duke University School of Medicine, Duke Molecular Physiology Institute.
    Objective: Alkaptonuria (AKU) is a rare autosomal recessive disease resulting from a single enzyme deficiency in tyrosine metabolism. As a result, homogentisic acid cannot be metabolized, causing systemic increases. Over time, homogentisic acid polymerizes and deposits in collagenous tissues, leading to ochronosis. Read More

    Smoothened-antagonists reverse homogentisic acid-induced alterations of Hedgehog signaling and primary cilium length in alkaptonuria.
    J Cell Physiol 2017 Nov 29;232(11):3103-3111. Epub 2017 Mar 29.
    Dipartimento di Biotecnologie, Chimica e Farmacia, Università degli Studi di Siena, Siena, Italy.
    Alkaptonuria (AKU) is an ultra-rare genetic disease, in which the accumulation of a toxic metabolite, homogentisic acid (HGA) leads to the systemic development of ochronotic aggregates. These aggregates cause severe complications mainly at the level of joints with extensive degradation of the articular cartilage. Primary cilia have been demonstrated to play an essential role in development and the maintenance of articular cartilage homeostasis, through their involvement in mechanosignaling and Hedgehog signaling pathways. Read More

    Operating the blues.
    Clin Case Rep 2016 Dec 5;4(12):1201-1202. Epub 2016 Oct 5.
    Department of Paediatric Cardiology Onassis Cardiac Surgery Centre Athens Greece.
    A 63-year-old man bearing most signs and symptoms (facial pigmentation, degenerative arthritis, and dark urine) pertinent to his known history of alkaptonuria underwent aortic valve replacement for critical aortic stenosis. Although rare, aortic stenosis is the most common cardiac manifestation of alkaptonuric ochronosis. Read More

    Use of skin-lightening products among selected urban communities in Accra, Ghana.
    Int J Dermatol 2017 Jan;56(1):32-39
    Department of Pathology, University of Ghana School of Biomedical and Allied Health Sciences, Accra, Ghana.
    Background: The practice of skin lightening has been reported from North America, Europe, Asia, and Africa. In literature, some prevalence rates exceed 50%, and both sexes are involved. Common agents used include hydroquinone, mercury, corticosteroids, and caustic agents. Read More

    Homogentisic acid induces aggregation and fibrillation of amyloidogenic proteins.
    Biochim Biophys Acta 2017 02 16;1861(2):135-146. Epub 2016 Nov 16.
    Dipartimento di Biotecnologie, Chimica e Farmacia, Università degli Studi di Siena, 53100, Siena, Italy. Electronic address:
    Background: Alkaptonuria (AKU) is an ultra-rare inborn error of metabolism characterized by homogentisic acid (HGA) accumulation due to a deficient activity of the homogentisate 1.2-dioxygenase (HGD) enzyme. This leads to the production of dark pigments that are deposited onto connective tissues, a condition named 'ochronosis' and whose mechanisms are not completely clear. Read More

    Skin Bleaching and Dermatologic Health of African and Afro-Caribbean Populations in the US: New Directions for Methodologically Rigorous, Multidisciplinary, and Culturally Sensitive Research.
    Dermatol Ther (Heidelb) 2016 Dec 11;6(4):453-459. Epub 2016 Nov 11.
    Department of Population Health Science and Policy, Center for Biostatistics, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
    Skin-bleaching practices, such as using skin creams and soaps to achieve a lighter skin tone, are common throughout the world and are triggered by cosmetic reasons that oftentimes have deep historical, economic, sociocultural, and psychosocial roots. Exposure to chemicals in the bleaching products, notably, mercury (Hg), hydroquinone, and steroids, has been associated with a variety of adverse health effects, such as Hg poisoning and exogenous ochronosis. In New York City (NYC), skin care product use has been identified as an important route of Hg exposure, especially among Caribbean-born blacks and Dominicans. Read More

    Long-term result of arthroplasty in the treatment of a case of ochronotic arthropathy.
    Acta Orthop Traumatol Turc 2016 Oct 3;50(5):584-586. Epub 2016 Nov 3.
    Bozok University Faculty of Medicine, Department of Orthopaedics and Traumatology, Turkey.
    Alkaptonuria is a rare metabolic disease caused by a partial or total deficiency of homogentisic acid oxidase, which results in excess homogentisic acid (HGA) levels. Homogentisic acid and its oxidation products can accumulate in hyaline cartilage, tendons, and ligaments. A 55-year-old male was admitted complaining of worsening chronic pain in his left knee. Read More

    Alkaptonuric Ochronosis.
    Urology 2017 Feb 2;100:e3-e4. Epub 2016 Nov 2.
    Department of Urology, Christian Medical College and Hospital, Vellore, Tamilnadu, India.
    Alkaptonuria is a rare autosomal recessive disorder of tyrosine metabolism. Deficiency of homogentisate 1,2 dioxygenase results in accumulation of oxidized homogentisic acid in the connective tissues of the skin, eyes and ears, musculoskeletal system, and cardiac valves, and in urolithiasis. Excretion of excessive homogentisic acid in urine causes dark-colored urine on exposure to air. Read More

    Ochronosis as Etiology of Requiring Total Knee Arthroplasty-A Case Series.
    Surg Technol Int 2016 Oct;XXIX:261-264
    Department of Orthopaedics, Seton Hall University, School of Health, and Medical Sciences, South Orange, NJ.
    Alkaptonuria is a rare hereditary metabolic disorder that leads to the accumulation of homogentisic acid accumulation and weakens the collagen, creating fissuring and articular cartilage degeneration. Therefore, we are reporting a multicenter case series of three patients (four arthroplasties) who presented with signs and symptoms of ochronotic arthropathy-and eventually underwent total knee arthroplasty (TKA)-and provide a review of the current literature on total joint arthroplasty in ochronotic osteoarthritis. Each patient achieved excellent Knee Society Scores (KSS) after at least a five-year follow-up-regardless of receiving cemented or cementless prostheses-and suffered no complications. Read More

    [Cutaneous depigmentation in black female population for cosmetic purposes: results of a KAP survey conducted in Abidjan (Ivory Coast)].
    Pan Afr Med J 2016 23;24:159. Epub 2016 Jun 23.
    Centre de Dermatologie du CHU de Treichville d'Abidjan, Côte d'Ivoire.
    Introduction: Cutaneous depigmentation for cosmeticis purposes is a widespread practice among black African women. It has many complications that have been well documented for decades. However, the reasons of practitioners are not well known. Read More

    Symptomatic pseudarthrosis in ochronotic spine: case report.
    J Neurosurg Spine 2017 Feb 14;26(2):220-228. Epub 2016 Oct 14.
    Birmingham Medical School, Birmingham, United Kingdom.
    In this study the authors report the first example of spinal pseudarthrosis in a patient with ochronosis, and they describe the application of posterior-only 360° surgery as an alternative approach to combined anterior-posterior surgery in the management of pseudarthrosis of an ankylosed spine, regardless of its etiology. Spinal involvement in ochronosis produces loss of flexibility and ankylosis of thoracic and lumbar segments. Pseudarthrosis is a serious complication of the diseases that present with ankylosis of the spine. Read More

    Alkaptonuric Ochronosis.
    J Assoc Physicians India 2016 Apr;64(4):79-80
    Assistant Professor, Department of Surgery, Mahatma Gandhi Medical College, Jaipur, Rajasthan.
    Alkaptonuria is an autosomal recessive metabolic disorder characterized by joints and spine involvement, ochronosis and presence of homogentisic acid in urine and its deposition in cartilage, intervertebral disc and other connective tissues, leading to disabling arthritis in elderly individual. Read More

    Tendons Involvement in Congenital Metabolic Disorders.
    Adv Exp Med Biol 2016;920:117-22
    Regenerative Medicine Laboratory, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.
    Congenital metabolic disorders are consequence of defects involving single genes that code for enzymes. Blocking metabolic pathways, the defect leads to the shortage of essential compounds, and/or to the accumulation of huge quantities of precursors, which interfere with normal functions. Only few of these diseases are characterized by a clinically significant tendon involvement. Read More

    Cytoskeleton Aberrations in Alkaptonuric Chondrocytes.
    J Cell Physiol 2017 Jul 31;232(7):1728-1738. Epub 2017 Jan 31.
    Dipartimento di Biotecnologie, Chimica e Farmacia, Università degli Studi di Siena, Siena, Italy.
    Alkaptonuria (AKU) is an ultra-rare autosomal genetic disorder caused by a defect in the activity of the enzyme homogentisate 1,2-dioxygenase (HGD) that leads to the accumulation of homogentisic acid (HGA) and its oxidized product, benzoquinone acetic acid (BQA), in the connective tissues causing a pigmentation called "ochronosis." The consequent progressive formation of ochronotic aggregates generate a severe condition of oxidative stress and inflammation in all the affected areas. Experimental evidences have also proved the presence of serum amyloid A (SAA) in several AKU tissues and it allowed classifying AKU as a secondary amyloidosis. Read More

    Ochronosis-like condition in a cat.
    Vet Dermatol 2016 Aug 26;27(4):311-e77. Epub 2016 May 26.
    Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, 4467 TAMU, College Station, TX, 77843-4467, USA.
    Background: Endogenous ochronosis is caused by a defect in the enzyme homogentisate 1,2-dioxygenase (HGD), which results in abnormal pigment deposition in the skin and urine abnormalities. Ochronosis previously has not been described histologically or ultrastructurally in a domestic animal species.

    Hypothesis/objectives: To describe the clinical, histopathological and ultrastructural findings in a case of aberrant pigmentation in a cat with features that resemble ochronosis. Read More

    Melasma and Post Inflammatory Hyperpigmentation: Management Update and Expert Opinion.
    Skin Therapy Lett 2016 Jan;21(1):1-7
    Spalding Drive Plastic Surgery and Cosmetic Dermatology, Beverly Hills, CA, USA.
    Dyschromia is a leading cause for cosmetic consultation, especially in those with diverse skin types (mixture of ethnicities) and with the rise of non-core and untrained physicians performing cosmetic procedures. Melasma and post-inflammatory hyperpigmentation (PIH) account for the majority of cases and are characterized by pigmented macules and patches distributed symmetrically in sun-exposed areas of the forehead, cheeks, and chin in melasma, and irregularly in areas of inflammation or an inciting traumatic event with PIH. Treatment is challenging and focused on a variety of mechanisms to stop, hinder, and/or prevent steps in the pigment production (melanocytic hyperactivity) process, breaking down deposited pigment for internal removal or external release, exfoliating cells to enhance turnover, and decreasing inflammation. Read More

    Ochronosis of the knee with secondary osteoarthritis requiring total knee replacement in a patient with cryptogenic organising pneumonia.
    BMJ Case Rep 2016 May 20;2016. Epub 2016 May 20.
    Department of Orthopedics, Alrijne Ziekenhuis, Leiderdorp, The Netherlands.
    Ochronosis is a rare autosomal recessive metabolic disease caused by homogentisic acid oxidase enzyme deficiency. High homogentisic acid levels will eventually result in black deposits in skin, sclerae, connective tissues and urine (alkaptonuria). It can lead to early degeneration of connective tissues and cartilage. Read More

    Neglected Alkaptonuric Patient Presenting with Steppage Gait.
    Arch Bone Jt Surg 2016 Apr;4(2):188-91
    Joint Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
    Even though intervertebral disc degeneration can be found in the natural course of alkaptonuria, detection of the disease by black disc color change in a patient without any other presentation of alkaptonuria is an exceptionally rare condition. We have reported a very rare case of alkaptonuria presented with low back pain and steppage gait in a 51-year-old male with a complaint of chronic low-back pain and steppage gait who was operated on for prolapsed lumbar disc herniation. Intraoperatively his lumbar disk was discovered to be black. Read More

    Alkaptonuria Presenting with Impressive Osteoarticular Changes and Severe Aortic Stenosis.
    Conn Med 2016 Mar;80(3):139-41
    Alkaptonuria, or ochronosis, a rare autosomal recessive metabolic disorder, causes an excess of homogentisic acid that results in dark pigmentation, calcification, and inflammation of cartilaginous and other tissues. Cardiovascular complications are also typical of the disease. We report the case of a 78-year-old male who presented with impressive osteoarticular changes and aortic stenosis associated with alkaptonuria. Read More

    Tyrosinase, could it be a missing link in ochronosis in alkaptonuria?
    Med Hypotheses 2016 Jun 8;91:77-80. Epub 2016 Apr 8.
    Lancaster Medical School, Faculty of Health & Medicine, Lancaster University, Lancaster, Bailrigg LA1 4YW, United Kingdom.
    The hypothesis that is proposed is that tyrosinase, an enzyme widely found within the human body is implicated in the ochronosis that occurs in alkaptonuria; an autosomal recessive condition first used by Archibald Garrod to describe the theory of "Inborn Errors of Metabolism." The disease results from the absence of a single enzyme in the liver that breaks down homogentisic acid; this molecule becomes systemically elevated in sufferers. The condition is characterised by a clinical triad of symptoms; homogentisic aciduria from birth, ochronosis (darkening) of collagenous tissues (from ∼30years of age) and ochronotic osteoarthropathy in weight bearing joints due to long term ochronosis in them (from ∼40years of age). Read More

    A Founder Effect for the HGD G360R Mutation in Italy: Implications for a Regional Screening of Alkaptonuria.
    JIMD Rep 2016 10;30:45-52. Epub 2016 Mar 10.
    Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
    We sought to establish rapid and specific genotyping methods for G360R mutation and for seven tightly linked markers in the homogentisate dioxygenase gene to address the question of whether G360R is a mutational hot spot or the result of a founder effect, as it has been repeatedly found in alkaptonuric patients from a geographic isolate in Italy.For G360R and single nucleotide polymorphism genotyping, high-resolution melting analysis was performed. Microsatellites were analysed by multiplex PCR and capillary electrophoresis. Read More

    Alkaptonuria: An example of a "fundamental disease"--A rare disease with important lessons for more common disorders.
    Semin Cell Dev Biol 2016 Apr 16;52:53-7. Epub 2016 Feb 16.
    Musculoskeletal Biology, University of Liverpool, Apex Building, Liverpool L7 8TX, UK; Clinical Biochemistry and Metabolism, Royal Liverpool University Hospital, Prescot Street,Liverpool L7 8XP, UK. Electronic address:
    "Fundamental diseases" is a term introduced by the charity Findacure to describe rare genetic disorders that are gateways to understanding common conditions and human physiology. The concept that rare diseases have important lessons for biomedical science has been recognised by some of the great figures in the history of medical research, including Harvey, Bateson and Garrod. Here we describe some of the recently discovered lessons from the study of the iconic genetic disease alkaptonuria (AKU), which have shed new light on understanding the pathogenesis of osteoarthritis. Read More

    Cervical Spondylotic Myelopathy due to the Ochronotic Arthropathy of the Cervical Spine.
    J Korean Neurosurg Soc 2016 Jan 20;59(1):65-8. Epub 2016 Jan 20.
    Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.
    Ochronosis is a musculoskeletal manifestation of alkaptonuria, a rare hereditary metabolic disorder occurs due to the absence of homogentisic acid oxidase and leading to various systemic abnormalities related to deposition of homogentisic acid pigmentation (ochronotic pigmentation). The present case reports the clinical features, radiographic findings, treatments and results of a cervical spondylotic myelopathy woman patient due to the ochronotic arthropathy of the cervical spine. The patient aged 62 years was presented with gait disturbance and hand clumsiness. Read More

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