Crystal arthropathy of the lumbar spine

Abstract

There have been very few reports in the literature of gout and pseudogout of the spine. We describe six patients who presented with acute sciatica attributable to spinal stenosis with cyst formation in the facet joints. Cytopathological studies confirmed the diagnosis of crystal arthropathy in each case. Specific formation of a synovial cyst was identified pre-operatively by MRI in five patients. In the sixth, the diagnosis was made incidentally during decompressive surgery. Surgical decompression alone was undertaken in four patients. In one with an associated degenerative spondylolisthesis, an additional intertransverse fusion was performed. Another patient had previously undergone a spinal fusion adjacent to the involved spinal segment, and spinal stabilisation was undertaken as well as a decompression. In addition to standard histological examination material was sent for examination under polarised light which revealed deposition of urate or calcium pyrophosphate dihydrate crystals in all cases. It is not possible to diagnose gout and pseudogout of the spine by standard examination of a fixed specimen. However, examining dry specimens under polarised light suggests that crystal arthropathy is a significant aetiological factor in the development of symptomatic spinal stenosis associated with cyst formation in a facet joint.

Spinal gout tophus: a very rare cause of radiculopathy

“…There were degenerative changes in our case, consistent with her age, and it was thought that this could contribute to the formation of spinal tophus. Crystal deposition is generally seen in the vertebral bodies in the spine, pedicles, lamina, ligamentum flavum, interapophyseal cartilage, intervertebral disc and epidural space [1,10,15]. In our case also, there were vertebral body, pedicle and neural foramen involvements.…”

“…Kelly et al [7] have reported that all the sections of the spine are equally involved in gout patients. While the most frequent involvement in the cases reported in the literature is the lumbar region, especially L4-5 region, furthermore thoracic and cervical region involvements are also seen [1,4,10]. Lumbar region involvement was present in our case.…”

“…Chang suggested that tophaceous accumulation started from the facet articulations and then spread to the ligamentum flavum [8]. This assumption is consistent with the lower pH values, which can accelerate the depositing of crystals, seen in facet articulations [2,10,13,15]. The period for the formation of tophi following the first episode of the acute gout arthritis is on average 10 years.…”

“…This formation of soft tissue masses is called tophus [4,9,10]. While tophus of the spinal column is rare, the occurrence of spinal gout tophus without systemic gout disease, as in our case, is even rarer [8,14].…”

“…The reason for the peripheral joints being involved more commonly in gout is considered to be related to the decrease of the solubility of the crystals in places with lower temperature and formation of tophi in the avascular tissues [8][9][10]. In addition, lower blood pH causes a decrease in the binding plasma proteins and trauma causes an increase in the precipitation of urate crystals, both of which cause the tophus formation to increase [5,8,10,13]. There were degenerative changes in our case, consistent with her age, and it was thought that this could contribute to the formation of spinal tophus.…”