Spinal gout: A review with case illustration

Elgafy, Hossein; Liu, Xiaochen; Herron, Joseph S.

doi:10.5312/wjo.v7.i11.766

Cited by 41 publications

(65 citation statements)

References 50 publications

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“…The various clinical presentations of spinal gout were described by Elgafy et al in a review of 68 cases of spinal gout [9]. The most common clinical presentation was back pain, followed by spinal cord compression, spinal nerve root compression, fever, cranial nerve palsy, and atlantoaxial subluxation.…”

Section: Discussionmentioning

confidence: 99%

A rare cause of back pain and radiculopathy – spinal tophi: a case report

Wan¹,

Teh²,

Jobli³

et al. 2019

J Med Case Reports

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BackgroundGout is a monosodium urate deposition disease which is prevalent worldwide. The usual manifestations are crystal arthropathy and tophi deposition in the soft tissues. Spinal tophi may also occur and are rarely reported, resulting in various clinical manifestations such as back pain, spinal cord compression, radiculopathy, and even mimicking epidural abscess and spondylodiscitis.Case presentationWe report a case of a 42-year-old Chinese man with underlying gout who presented with back pain and radiculopathy. The diagnosis of spinal tophi was unsuspected and he was initially treated for epidural abscess and spondylodiscitis. He underwent a laminectomy and posterolateral fusion during which tophus material was discovered. He recovered and medications for gout were started.ConclusionSpinal tophi are rare. The diagnosis is difficult and spinal tophi may be mistaken for epidural abscess, spondylodiscitis, or neoplasm.

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Section: Discussionmentioning

confidence: 99%

A rare cause of back pain and radiculopathy – spinal tophi: a case report

Wan¹,

Teh²,

Jobli³

et al. 2019

J Med Case Reports

View full text Add to dashboard Cite

show abstract

“…In many spinal gout cases, the laboratory finding shows elevated serum uric acid level of above 7.0mg/dL4,7,14). Our patient also showed elevated serum uric acid level of 10.4mg/dL.…”

Section: Discussionmentioning

confidence: 99%

“…Nonsteroidal anti-inflammatory drugs (NSAIDs), colchicine, and xanthine oxidase inhibitors, such as allopurinol and febuxostat, are the key drugs4,16). We applied NSAIDs postoperatively; however, the symptoms did not improve.…”

Section: Discussionmentioning

confidence: 99%

Tophaceous Gout in the Lumbar Spinal Canal Mimicking Epidural Spinal Tumor

Kim

et al. 2017

Korean J Spine

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Gout is an inflammatory arthritis characterized by deposition of monosodium urate crystals in joints. Though gout frequently involves the big toe or other extremities, it rarely occurs in the spinal canal. A 35-year-old man presented with left L5 radiculopathy. He had leg pain for 8 months and received several epidural steroid injections. Magnetic resonance imaging revealed a 1.7×1.1-cm ovoid contrast-enhancing mass, causing pressure erosion of the left L5 pedicle. Microscopic laminotomy was performed at the left L5 lamina. White chalky materials, identified at the left lateral recess of the spinal canal, were removed in a piecemeal manner. The histopathologic diagnosis was tophaceous gout. Although the patient’s radiating pain did not resolve postoperatively, it was dramatically relieved with uric acid-lowering medications. If a mass effect is suspected, surgical removal of gouty tophi might aid in symptom release and definite diagnosis. Medical treatment after rheumatology consultation is crucial.

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“…According to the literature, the patients who underwent surgery had a favorable outcome. 36 Needle biopsy plays an important role in patients without neurological compromise, as it helps confirmation of diagnosis and the initiation of medical conservative therapy, preventing unnecessary surgical risks. 37 Regardless of surgical or conservative treatment, compliance with maintenance treatment of gout is mandatory for disease control.…”

Section: Discussionmentioning

confidence: 99%

Lumbar spinal stenosis attributable to tophaceous gout: case report and review of the literature

Wang

Cai

et al. 2017

TCRM

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ObjectivesTophaceous gout seldom affects the axial skeleton. Symptoms vary according to the differential localization of urate deposits and the diagnosis is often delayed. Here, we report an unusual case of lumbar spinal stenosis caused by extradural tophaceous deposits.MethodsWe retrospectively reviewed a case of a patient with tophaceous gout of the lumbar spine and reviewed the relevant literature.ResultsA 62-year-old man with a 2-year history of lower back pain and a 3-month history of lower limb radiation pain and intermittent claudication was admitted. After laboratory and imaging investigations he underwent surgical decompression and stabilization. Histological analysis of the extracted specimen confirmed that it was gouty tophus. The patient’s symptoms improved progressively after the operation. He recovered very well with no complications.ConclusionThe mechanism associated with axial gout is not yet clear. Obesity, inactivity, and previous degenerative disc disease may be the risk factors for spinal tophus. The clinical symptoms are diverse according to the differential localization of urate deposits. It is not easy to diagnose this disease radiographically by routine radiological examination. Analysis of a biopsy specimen is definitely the only way to confirm diagnosis. Surgical treatment should be considered in patients with spinal gout who are experiencing neurological deterioration.

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Spinal gout: A review with case illustration

Cited by 41 publications

References 50 publications

A rare cause of back pain and radiculopathy – spinal tophi: a case report

A rare cause of back pain and radiculopathy – spinal tophi: a case report

Tophaceous Gout in the Lumbar Spinal Canal Mimicking Epidural Spinal Tumor

Lumbar spinal stenosis attributable to tophaceous gout: case report and review of the literature

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