Case: We report a case of postoperative left-sided Horner syndrome (blepharoptosis, miosis, and anhidrosis) after revision surgery for cervical spondylotic myelopathy. A C4 corpectomy and an anterior cervical fusion from C3 to C5 were performed through a left longitudinal approach in a patient with a surgical history of an anterior discectomy and a fusion from C5 to C6. One year after the revision surgery, the patient had recovered from the anhidrosis and the miosis, but the blepharoptosis was not fully resolved. Conclusion: Horner syndrome resulting from surgical injury to the ipsilateral cervical sympathetic chain is a very rare complication of anterior spine surgery that has been reported when the lower cervical levels have been approached. Awareness of this important cervical structure may help to avoid this complication.
Alkaptonuria 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 (ochronosis) and urine (alkaptonuria). It can lead to early degeneration of joints. The diagnosis is often delayed because of its low prevalence and non-specific early symptoms. We describe a clinical presentation of ochronotic arthropathy, on a complex patient, who developed a septic arthritis of the knee. The patient was under immunosuppressive therapy, due to a previous colon adenocarcinoma and received a knee corticosteroid infiltration, two weeks before the onset of pain. It was performed joint lavage and arthrolysis by arthrotomy. During the procedure, we found a dark pigmentation on bone. Urine tests were positive for alkaptonuria. The patient completed an antibiotic cycle and rehabilitation, with satisfying improvement in knee's range of motion. At four years follow-up the patient can walk without crutches, presents minor knee pain. High level of suspicion and awareness is needed to diagnose ochronosis. The joint destruction in a complex patient must be carefully analysed. We've chosen a non-aggressive therapeutic management, but according to the literature, other therapeutic strategies could have also been chosen, like joint arthroplasty. We've declined this option because the patient is still doing antineoplastic treatment.
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