Severe back pain and lower extremities weakness in a young male

Nasseri, Farbod; Myers, Anita M.; Shah, Krupal R.; Moron, F E

doi:10.1259/bjr.20110685

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…11 To the best of our knowledge, 21 thoracic spine cases have been reported. The reported cases of spinal gout involvement of thoracic vertebrae are listed in Table 2. 7, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30 There was significant gender difference with a male-to-female ratio of 17:4 in the reported cases. Fourteen (66.7%) patients reported a history of gout symptom ranging from 2 to 35 years.…”

Section: Discussionmentioning

confidence: 72%

“…The most common location of gouty tophi involvement was extradural space. 11, 13, 14, 15, 16, 18, 21, 22, 25, 26 Other locations of axial elements, such as facet joints, 23, 29, 30 discs, 12 vertebral bodies, 7, 12, 17, 19, 20 pedicles 7, 13, 27, 30 and costovertebral joint 28 have been reported. However, the formation of gouty tophi within the thoracic spine involving the ligamentum flavum causing spinal cord compression, as occurs in our case, have only been reported previously by Wang et al 23 and Hus et al 24 …”

Section: Discussionmentioning

confidence: 99%

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Thoracic cord compression due to ligamentum flavum gouty tophus: a case report and literature review

Xing

et al. 2015

Spinal Cord

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Study design:Here we describe a patient who developed myelopathy due to gouty tophi of the ligamentum flavum in the thoracic spine. We also review similar cases previously reported in the literature.Objective:Our aim was to present a case of myelopathy due to thoracic spinal gouty tophus.Methods:We report the case of a 56-year-old male with history of peripheral gout and renal insufficiency. The patient complained of back pain and paraparesis of the left lower limb. Multiple tophi were noted over several interphalangeal and metatarsophalangeal joints. Neurological examination showed decreased left lower limb strength and a positive Babinski sign. Magnetic resonance imaging of the thoracic spine revealed hypertrophy of the ligamentum flavum at the level of T3/T4, T5/T6, T9/T10, T10/T11 and T11/T12.Results:A thoracic laminectomy at T1-T5 was performed. Chalky white granular material was found in the ligamentum flavum during surgery. Histological analysis of the specimen demonstrated a gouty tophus. The patient's back pain and paraparesis of the lower left limb improved.Conclusion:The clinician should include spinal gout in the differential diagnosis when dealing with patients with gout and axial pain with or without neurologic deficits. If this diagnosis is seriously entertained, then a CT scan or magnetic resonance imaging as well as tissue biopsy may be needed to establish the diagnosis.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Thoracic cord compression due to ligamentum flavum gouty tophus: a case report and literature review

Xing

et al. 2015

Spinal Cord

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“…Severe back pain and lower extremities weaknesses have been reported in altered levels of vitamin D and uric acid. 5 We strongly recommend early and regular screening for vitamin D, Calcium, and uric acid as part of a comprehensive health assessment for low back pain.…”

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confidence: 99%

Management of Calcium, Vitamin D, and Uric-Acid Levels for Spinal Pain

Chaudary

Shahid

2022

Pak J Neurol Surg

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Low back pain is incredibly painful and demoralizing due to the physical restrictions it causes as well as the psychological ramifications it brings. The calcium and alkaline phosphatase were favorably connected with vitamin D. The issue of low back discomfort presents a difficulty to healthcare practitioners. In developing nations, the problem is exacerbated by a failure to report for early treatment, vocational compulsions in rural regions, and sedentary lifestyles among urban youngsters 1. In Pakistan, there was a significant incidence of vitamin D insufficiency, with 53.5 percent of residents studied being vitamin D deficient, 31.2 percent being inadequate vitamin D, and just 15.3 percent having normal vitamin D (25-hydroxyvitamin D) levels. High levels of Vitamin D insufficiency were also seen, regardless of the various quantities of sunlight in the five city sites 2. In observational studies, consumption of carbonated beverages has been linked to an increased risk of fracture. The most common reason is that one or more of the beverage ingredients raise urine calcium. 3 There is a role of optimized levels of calcium, vitamin D & uric Acid in order to treat patients with low backaches. 1,4 The over intake of carbonated caffeine drinks and artificial fruit juices adversely impacts the proper absorption of vitamin D and calcium. Hence, good doses of supplements of Vitamin D and Calcium should be optimized for patients reporting muscles and joint pains. Severe back pain and lower extremities weaknesses have been reported in altered levels of vitamin D and uric acid. 5 We strongly recommend early and regular screening for vitamin D, Calcium, and uric acid as part of a comprehensive health assessment for low back pain.

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Thoracic gout tophus with abdominal wall protrusion

Kao¹,

Wang²,

Leng

et al. 2020

Medicine

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Rationale: A patient presented the abdominal wall protrusion due to tophaceous gout of the spine. Similar cases were not reported in the literature. This study aimed to report a case of tophaceous gout of the spine with abdominal wall protrusion. Patient concerns: A 38-year-old male patient had a 10-year history of gout and hyperuricemia. He complained of back pain and abdominal wall protrusion. Diagnoses: The patient was diagnosed with tophaceous gout of the spine with abdominal wall weakness caused by T11 nerve root compression. Interventions: A semi-lamina decompression was performed at T11-T12. The pathological examination of the specimen demonstrated tophaceous gout of the spine. Outcomes: After the surgery, the patient's back pain was completely relieved and the abdominal wall weakness significant improved. Lessons: This case highlighted that axial gout could mimic thoracic disk herniation clinically. The abdominal wall weakness might also be due to single T11 nerve compression by the tophaceous gout of the spine. In patients with a history of gout, axial gout should be considered as one of the differential diagnoses.

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Severe back pain and lower extremities weakness in a young male

Cited by 3 publications

References 6 publications

Thoracic cord compression due to ligamentum flavum gouty tophus: a case report and literature review

Thoracic cord compression due to ligamentum flavum gouty tophus: a case report and literature review

Management of Calcium, Vitamin D, and Uric-Acid Levels for Spinal Pain

Thoracic gout tophus with abdominal wall protrusion

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