Gouty Arthropathy of the Axial Skeleton Causing Cord Compression and Myelopathy

Abstract

Can. J. Neurol. Sci. 2011; 38: 918-920 A 70-year-old Caucasian female with a past medical history of hypertension, chronic renal insufficiency, dyslipidemia, hypothyoidism, anemia, congestive heart failure, recent humeral fracture, and longstanding gout, presented with a one-year history of progressive weakness and falls, increasing "clumsiness" in her hands and weakness of the lower extremities. Bowel and bladder function were intact.On examination, resistance in the lower extremities was reduced, sensation was diminished bilaterally, and hyperreflexia with sustained ankle clonus noted.Computed tomogram (CT) and magnetic resonance imaging (MRI) of the spine (Figures 1 and 2) revealed a bilateral destructive process involving the posterior elements of T1 and T2, centered on the facet joints. There was anterior listhesis of T1 on T2 and increased T2 signal within the spinal cord. She underwent posterior decompression with instrumented fusion. Surgical pathology of the spinal mass was sent for histology and crystal analysis (Figure 3). Monosodium urate crystals were detected. The patient's deficits gradually improved postoperatively and the management of her gout (Serum Uric Acid [SUA] at presentation 792 umol/L) was optimized.Gouty arthropathy of the axial skeleton is well-described, affecting up to 17% of patients with chronic gout and is typically localized to the sacroiliac joints and the facet joints of spinal https://www.cambridge.org/core/terms. https://doi

Gout in the thoracic spine causing acute paraplegia: illustrative case

“…She presented with absence of sensory and motor function of both legs of 2 weeks’ duration. Finally, Ibrahim et al 6 reported a case of thoracic spinal cord compression at the T1–2 levels caused by gouty arthropathy in a 70-year-old woman with a 1-year history of progressive weakness in her hands and lower extremities who presented with upper motor neuron paralysis of her legs.…”

Axial Gout: Cinderella of Gouty Arthropathy!

“…Published cases mainly coalesce around the progression of inflammatory back pain to catastrophic neurological involvement 6,7,8 . Although these cautionary cases of axial involvement are likely rare, there is clearly interest and concern across specialties regarding the need for carefully constructed collective investigations to elucidate the contribution of axial gouty arthropathy.…”