{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T11:24:27Z","timestamp":1764588267443},"reference-count":9,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>Alkaptonuria (AKU) is a rare hereditary disorder in which excess homogentisic acid (HGA) deposits in connective tissues (ochronosis). Here, we report the unusual presentation of a lumbar disc herniation occurring in a patient with AKU warranting surgical intervention.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Case Description: <\/jats:title>\n<jats:p>A 28-year-old male presented with 1 year of low back pain. The lumbar magnetic resonance imaging showed an extruded disc at the L4-L5 level accompanied extensive disc space narrowing and osteophyte formation. At surgery, the interspinous ligaments, facet joints, and disc herniation were black. In addition, the postoperative re-examination revealed a black discoloration of the nasal and ear cartilage. Finally, the diagnosis of AKU was confirmed when the urine specimen was positive for HGA.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>Rarely, younger patients with AKU who develop excess black deposits of HGA in connective tissues (i.e., ochronosis) may present with lumbar disc herniations and spondylosis.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_1178_2021","type":"journal-article","created":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T09:06:12Z","timestamp":1641978372000},"page":"15","update-policy":"http:\/\/dx.doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Neglected alkaptonuric patient presented with low back pain and radiculopathy: A case report"],"prefix":"10.25259","volume":"13","author":[{"given":"Mohammad Moein","family":"Vakilzadeh","sequence":"first","affiliation":[{"name":"Student Research Committe, Mashhad University of Medical Sciences, Mashhad, Iran,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sajjad","family":"Saghebdoust","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Razavi Hospital, Mashhad, Iran,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bita","family":"Abbasi","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mashhad University of Medical Sciences, Mashhad, Iran."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reza","family":"Zare","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Razavi Hospital, Mashhad, Iran,"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2022,1,12]]},"reference":[{"key":"10.25259\/SNI_1178_2021\/ref-1","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1007\/s002340000428","article-title":"A case of ochronosis: MRI of the lumbar spine","volume":"42","author":"Choudhury","year":"2000","journal-title":"Neuroradiology"},{"key":"10.25259\/SNI_1178_2021\/ref-2","first-page":"2194","article-title":"Inherited disorders of amino acid metabolism and storage","volume-title":"Harrison\u2019s Principles of Internal Medicine","author":"Elsas","year":"1998","edition":"14th ed"},{"key":"10.25259\/SNI_1178_2021\/ref-3","first-page":"87","article-title":"Alkaptonuria and lumbar disc herniation: Report of three cases","volume":"98","author":"Farzannia","year":"2003","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_1178_2021\/ref-4","doi-asserted-by":"crossref","first-page":"348","DOI":"10.3171\/jns.1963.20.4.0348","article-title":"Ochronosis with ruptured lumbar disc: Case report","volume":"20","author":"Feild","year":"1963","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_1178_2021\/ref-5","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1038\/ng0996-19","article-title":"The molecular basis of alkaptonuria","volume":"14","author":"Fern\u00e1ndez-Ca\u00f1\u00f3n","year":"1996","journal-title":"Nat Genet"},{"key":"10.25259\/SNI_1178_2021\/ref-6","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1007\/s00701-006-0774-9","article-title":"Ochronosis and lumbar disc herniation","volume":"148","author":"G\u00fcrkanlar","year":"2006","journal-title":"Acta Neurochirurg"},{"key":"10.25259\/SNI_1178_2021\/ref-7","doi-asserted-by":"crossref","first-page":"134","DOI":"10.3944\/AOTT.2013.2767","article-title":"Alkaptonuric patient presenting with \u201cblack\u201d disc: A case report","volume":"47","author":"Kahveci","year":"2013","journal-title":"Acta Orthop Traumatol Turcica"},{"key":"10.25259\/SNI_1178_2021\/ref-8","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/S0021-9258(18)70560-7","article-title":"The nature of the defect in tyrosine metabolism in alcaptonuria","volume":"230","author":"La Du","year":"1958","journal-title":"J Biol Chem"},{"key":"10.25259\/SNI_1178_2021\/ref-9","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1302\/0301-620X.52B4.653","article-title":"Ochronotic arthropathy: A review with four case reports","volume":"52","author":"Laskar","year":"1970","journal-title":"J Bone Joint Surg Br"}],"container-title":["Surgical Neurology 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