Spinal Cord Compression Due to Tophaceous Vertebral Gout: A Case Report

Abstract

Gout tophi are deposits of urate crystals in subcutaneous tissues and joints which commonly affect the small joints of the feet and hands, causing painful arthritis. The axial skeleton is considered to be seldom affected by gout arthritis. Here we describe the clinical, MRI, and pathologic findings of a 61-year-old male patient with a previous diagnosis of gout who presented with progressive paraparesis and radicular pain. MRI showed extradural masses compressing the spinal cord and roots at two spinal levels. Two surgical interventions were performed to remove these extradural masses, which were pathologically identified as gout tophi. Pain and paraparesis had clinical improvement after surgery. This report highlights that gout can be a cause of paraparesis.

Spinal gout with intervertebral foramen infiltration: A rare case perfectly mimicking degenerative lumbar disc disease

“…For spinal gout, the most affected locations are the lumbar region and sacroiliac joints. In the vertebral column, gout tophi can affect almost every anatomical component, such as vertebral bodies, intervertebral disc, epidural space, articular facets, laminae, ligamentum flavum, pedicles and rarely the intradural space ( 5 ). It was also reported that the lateral parts of the vertebra are much more affected than the central areas ( 6 ); however, the sole infiltration of the intervertebral foramen was never reported.…”

“…To our knowledge, the present case with lesions of spinal gout tophus in the intervertebral foramen was the first of its kind reported in the literature. The initially reported cases were all massive compressing lesions in the lumbar spinal canal with definite clinical symptoms, such as in the studies by Chen et al ( 3 ), Abreu Casas et al ( 5 ), Ribeiro da Cunha et al ( 7 ), Brahmbhatt et al ( 8 ) and Kim et al ( 15 ). Compared with the previous publications, the MRI appearance reported in the present study was more difficult to differentiate from degenerative spinal disorders.…”

“…However, it should always be considered before an open surgery is performed. Strict metabolic control of the diet and pharmacological treatment or anti-inflammatory medications should be optimized in order to avoid surgery ( 5 , 9 ).…”

“…More severe cases may present with acute onset paraparesis ( 4 ). Spinal gout may affect the vertebral bodies, the joint facets, the flavum ligament and the pedicles ( 5 ). Differential diagnoses of spinal gout include ossification of the ligamentum flavum, stenosis of the spinal canal, lumbar disc herniation and other degenerative spinal disorders.…”

La goutte spinale: une présentation inhabituelle de deux cas et revue de la littérature

“…La goutte chronique tophacée polyarticulaire est le quatrième et ultime stade évolutif de la maladie goutteuse [5]. Le 1er cas de goutte axiale fut décrit en 1950 par Kersley GD sur un cas autopsique de subluxation par érosion tophique de l'Atlas (C1) avec protrusion de l'Odontoïde dans le Foramen Magnum [6,7,8]. Koskoff YD et al décrivait 3 ans plus tard la première myélopathie goutteuse et Reynolds AF Jr en 1976, les 3 premiers cas neurochirurgicaux de goutte rachidienne par tophi flavo-ligamentaires (ligament jaune) compressifs [6], comme retrouvé dans nos 2 cas.…”