Gout in the thoracic spine causing acute paraplegia: illustrative case

Koro, Lacin; Khanna, Raman; Richards, Dominick; Karahalios, Dean G.

doi:10.3171/case21308

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…Современные подходы к хирургическому лечению подагрических спондилоартритов заключаются в выполнении декомпрессивной ламинэктомии с одновременной ревизией позвоночного канала и удалением параартикулярных и эпидуральных тофусов [32,33,34,35]. При наличии вертеброгенной нестабильности операция дополнялась транспедикулярной стабилизацией [13,15,17].…”

Section: характеристика работ включенных в систематический обзорunclassified

“…В свою очередь тактика применения антибактерильной терапии, по данным литературы, базируется на эмпирическом подходе ввиду крайне низкой частоты верификации возбудителя, препаратами выбора являются трициклические гликопептиды (ванкомицин) и цефалоспорины 3-4-го поколения [6,28,34]. Необходимо отметить, что в отличие от данных литературы в исследуемой нами клинической серии бактериологическое исследование операционного послеоперационного материала позволило выявить различные штаммы золотистого и эпидермального стафилококка (в том числе 3 случая нозокомиальной инфекции: MRSA, MRSE) и назначить этиотропную антибактериальную терапию с учетом лекарственной чувствительности возбудителей.…”

Section: характеристика работ включенных в систематический обзорunclassified

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Chronic pyogenic spondylitis in patients with spinal gout: a case series and literature review

Vishnevskiy,

Naumov,

Shchelkunov

et al. 2024

Traumatology and Orthopedics of Russia

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The aim of the study. To analyze of the follow-up results of surgical treatment of chronic pyogenic spondylitis in patients with spinal gout and systematize the literature data on the issue. Methods. Design – case series and literature review. The clinical part of the study included 6 consecutively operated patients from 2018 to 2021. The diagnosis of spinal gout and chronic pyogenic spondylitis was verified according to the results of histologic and bacteriologic studies of surgical material. Follow-up results evaluated at least 24 months. The peculiarities of clinical and laboratory, radiological and histologic manifestations of the disease were studied. Literature data systematization was carried out using the medical databases PubMed, Google Scholar, eLIBRARY. The depth of the search was from 2013 to 2023. Results. The average age of the patients was 55 ± 9 years. The duration of the diagnostic pause was 8 ± 5 years. Multisegmented lesions of the lumbar (n1 = 4) and thoracic (n2 = 2) spine prevailed. According to the classification of Pola E. et al. (2017) the following types of spondylitis were identified: B3 (n3 = 1), C1 (n4 = 1), C3 (n5 = 2) and C4 (n6 = 2). The clinical presentation was dominated by chronic back pain, with an intensity of 6.1 ± 1.4 VAS scores. Neurologic disorders of the lower extremities and pelvic (ASIA scale) corresponded to types B (n7 = 1) and C (n8 = 4). The type of surgery: three-column reconstruction from combined approach in 2 cases and anterior column reconstruction in 2 cases, three-column reconstruction from posterior approach in 1 case, and debridement of the epidural space and anterior column from posterior approach in 1 case. The literature review is based on 17 publications, analyzed at the final stage.

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Section: характеристика работ включенных в систематический обзорunclassified

Chronic pyogenic spondylitis in patients with spinal gout: a case series and literature review

Vishnevskiy,

Naumov,

Shchelkunov

et al. 2024

Traumatology and Orthopedics of Russia

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“…Despite traditional beliefs that spinal gout is rare, recent studies show it is more prevalent than reported because of underdiagnosis [ 3 ]. Nevertheless, such presentation in a patient who was never diagnosed with gout or hyperuricemia is rare [ 4 ]. This causes diagnostic challenges and potential treatment delays.…”

Section: Introductionmentioning

confidence: 99%

Unusual Cause of Cord Compression in a Patient with Chronic Lymphocytic Leukemia

Gebreselassie¹,

Valancius²,

Ranic

et al. 2023

Am J Case Rep

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Patient: Male, 65-year-old Final Diagnosis: Gout Symptoms: Back pain • weaknes of lower limbs Clinical Procedure: — Specialty: General and Internal Medicine Objective: Unusual clinical course Background: Spinal gout is not so uncommon. The numbers of case reports are low because of underdiagnosis. Nevertheless, the presentation of spinal gout in a patient who was never diagnosed with gout or hyperuricemia is rare. In addition, the probability of occurrence of spinal gout at the thoracic spine is low, making this case unique. Late or missed diagnosis causes treatment delays with grave outcomes. Case Report: A 65-year-old man with a past medical history of chronic lymphocytic leukemia presented with rapid and progressive weakness of the lower extremities that led to complete paraplegia over 2 weeks. Magnetic resonance imaging showed severe central canal stenosis with disc protrusion and a T4-5 ventral mass with abnormal marrow signaling. The margins at the erosion were sclerotic, and malignancy was top on the differential diagnosis. Open minimally invasive laminectomy with discectomy at T4-5 was done. Sections on the biopsy specimen demonstrated fragments of benign cartilage and bone and multiple granulomas palisading around areas of crystalline material, consistent with tophaceous gout. He was started on a urate-lowering treatment per the American College of Rheumatology guideline. Unfortunately, due to the late patient presentation, neurologic recovery was not possible. Conclusions: This case report illustrates an unusual presentation of gout with a catastrophic complication that could have been prevented with early diagnosis and treatment. Some reports have described patients with tophaceous deposits in the absence of gout flare among patients with urate overproduction due to myeloproliferative disorders. Further studies are needed to explore such relationships.

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percutaneous endoscopic interlaminar lumbar decompression for intraspinal tophaceous gout surrounded by dural sac: a case report and literature review

Xu,

Dong,

Dong

2024

Preprint

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Background Intraspinal tophaceous gout is a rare causative factor for spinal stenosis and neurological impairment. The most common treatment is laminectomy with or without fusion through an open approach. Yet, this excessively destroys normal tissues such as the lamina, facet joints, posterior ligamentous complex, and paravertebral muscles, increasing the risk of postoperative spinal instability and chronic back pain. The aim of current study was to analyze the surgical efficacy of percutaneous interlaminar endoscopy in the treatment of intraspinal tophaceous gout encased by the dural sac. Case presentation: A 31-year-old male complained of back pain and radiative pain in the right lower extremities for one year. Preoperative dual-energy CT (DECT) showed patchy extensive urate crystal deposition in the L4-L5 spinal canal and multiple facet joints. The patient underwent percutaneous endoscopic decompression via lumbar interlaminar approach. Multiple chalky white mass was found compressing the dural sac and nerve roots endoscopically. Pathologic results confirmed the diagnosis of lumbar intraspinal tophi. Postoperative MRI showed no significant compression of the dural sac and nerves, and CT showed no significant destruction of the facet joints. The patient's symptoms improved rapidly following the procedure. Conclusion Intraspinal tophaceous gout is rare. DECT is highly recommended for diagnosis when suspecting intraspinal tophaceous gout. This study reports a case of percutaneous endoscopic treatment of a patient with intraspinal tophaceous gout encased by the dural sac. We believe this surgical approach provides a new option for the treatment of lumbar spinal tophaceous gout because it provides adequate decompression without impaires joint stability. Percutaneous endoscopic decompression also has the following benefits: less bleeding, lower hospital expenses, and shorter hospitalization.

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Gout in the thoracic spine causing acute paraplegia: illustrative case

Cited by 5 publications

References 11 publications

Chronic pyogenic spondylitis in patients with spinal gout: a case series and literature review

Chronic pyogenic spondylitis in patients with spinal gout: a case series and literature review

Unusual Cause of Cord Compression in a Patient with Chronic Lymphocytic Leukemia

percutaneous endoscopic interlaminar lumbar decompression for intraspinal tophaceous gout surrounded by dural sac: a case report and literature review

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