Spinal Manifestations of Endemic Skeletal Fluorosis: Clinical Spectrum, Surgical Outcomes, and Literature Review

Background: Skeletal fluorosis is a chronic metabolic bone disease caused by excessive fluoride intake, representing a major public health issue in India, China, and other endemic regions. While dental fluorosis serves as an early warning sign, skeletal fluorosis results in osteosclerosis, ligament ossification, deformity, and neurological compression. Spinal canal stenosis caused by fluorosis remains under-recognized yet debilitating. Objective: To share institutional experience with 100 surgically treated cases of fluorotic lumbar canal stenosis and review worldwide literature on skeletal fluorosis. Methodology: Retrospective analysis of 100 patients who underwent decompressive surgery for fluorotic lumbar canal stenosis at Kamineni Institute of Medical Sciences. Clinical, radiological, and biochemical data were analyzed. All patients underwent posterior decompressive surgery tailored to the stenosis type. Outcomes were assessed using the Visual Analog Scale, claudication distance, and Oswestry Disability Index, with follow-up at 3, 6, and 12 months. Relevant global literature was reviewed for comparison. Results: The mean age was 46 years, with a male-to-female ratio of 1.4:1. All patients had back pain and stiffness, 80% presented with neurogenic claudication, and 40% had radiculopathy. Radiology confirmed universal osteosclerosis, with posterior longitudinal ligament ossification in 35%. Urinary fluoride averaged 2.9 ppm, with 55% showing Vitamin D deficiency. Central canal stenosis occurred in 50%, lateral recess stenosis in 30%, and combined stenosis in 20%. Decompressive laminectomy with or without facetectomy resulted in excellent outcomes in 80%, good outcomes in 16%, and poor outcomes in 4%. Complications were minimal, with dural tears in 4% and no postoperative instability. Conclusion: Skeletal fluorosis is a preventable disease with potentially disabling spinal involvement. Surgical decompression yields excellent results in symptomatic canal stenosis. Preventive measures, including safe water, defluoridation, calcium, and Vitamin D supplementation, remain the mainstay of control.