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

Abstract

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.