Thoracic Myelopathy Due to Compression by the Epidural Tophus

Yasuhara, Kazuaki; Tomita, Yutaka; Takayama, Atsuya; Fujikawa, Hiromasa; Otake, Yoshiharu; Takahashi, Kazuhisa

doi:10.1097/00002517-199407010-00012

Cited by 17 publications

(7 citation statements)

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“…8,13,22,23,26,35 At the thoracic level (14 cases), the tophi present as chalky white, avascular tophaceous material in the epidural space leading to spinal cord compression. 5,6,[15][16][17] In the lumbar area, the most frequently affected (25 cases), the radicular compression is linked to the massive infiltration of the ligaments by the gouty tophi. 2,3,8,20 In the patients with sacroiliac gout, deposits of urate crystals were found in the hyaline cartilage within the articular space and adjacent bone.…”

Section: Discussionmentioning

confidence: 99%

Spinal Gout

Draganescu¹,

Leventhal²

2004

JCR: Journal of Clinical Rheumatology

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Spinal involvement is considered to be a rare complication of gout. We report a case of a 48-year-old woman with chronic tophaceous gout, recently desensitized to allopurinol, who presented with an L4 radiculopathy. A magnetic resonance image (MRI) of the lumbosacral spine revealed an extradural process at L4 level. Three months before this episode, for unrelated reasons, the patient had an MRI of her entire spine, which was normal. Laminectomy was performed revealing a large gouty tophus. The fact that a large gouty tophus formed over this short a period of time causing neurologic symptoms highlights the importance of aggressive medical management of patients with longstanding tophaceous gout with urate-lowering agents. Spinal extradural gout could lead to neurologic deficits necessitating emergent surgery for decompression, exposing the patient to further risk. Every effort should be made to lower the serum uric acid level by maximizing the pharmacologic regimen and, if necessary, desensitizing the patient, like in our case, if there is a history of allergy to allopurinol.

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Section: Discussionmentioning

confidence: 99%

Spinal Gout

Draganescu¹,

Leventhal²

2004

JCR: Journal of Clinical Rheumatology

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“…4,5 An analysis of the literature indicated that all segments of the spine could be involved with gout. [6][7][8][9] The lower lumbar spine is the most common region involved, particularly the L4-5 level. [10][11][12][13] Only 20 cases of tophus in the dorsal vertebrae have been described in the literature (see Table 1 6-20 ).…”

Section: Discussionmentioning

confidence: 99%

Thoracic spinal cord compression by extradural tophus: a case report and review of the literature

Liu

Zhu

2015

Spinal Cord Ser Cases

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STUDY DESIGN: Case report and literature review. OBJECTIVES: Gouty arthritis of the spine is rare. Gout presenting as back pain and quadriplegia may be difficult to distinguish from a spinal tumor. Symptoms vary, and the diagnosis is often delayed. We report an unusual case of thoracic spinal cord compression caused by extradural tophaceous deposits whose initial diagnosis had been lymphoid malignancy. To the best of our knowledge, this is only the second report of using single-photon emission computed tomography (SPECT) to diagnose spinal tophus. METHODS: We retrospectively reviewed the medical records, operative reports and radiographic imaging studies of a single patient. RESULTS: A 26-year-old man with severe tophaceous gout presented with a 4-month history of progressive weakness and dyschesia of both lower extremities. Coronal bone slices evaluated by SPECT indicated increased methylene diphosphonate uptake in the T9 and T10 pedicles. Pathology assessment revealed areas of amorphous substance containing urate crystals surrounded by inflammatory cells. The diagnosis was gouty tophus. CONCLUSION: The position of the spinal tophus may be related to the 'S' type of spinal anatomical structure. Obesity and inactivity may be the two risk factors for spinal tophus. Every effort should be made to lower the serum uric acid level by maximizing the pharmacological regimen. We believe that laminectomy can effectively relieve spinal cord compression. It also improves the longterm prognosis for spinal gouty tophus. SPECT may be a viable method for differentiating spinal gout and a malignant tumor. Spinal Cord Series and Cases INTRODUCTIONWe report a case of gouty arthritis affecting the thoracic spine in a 26-year-old man with thoracic spinal cord compression caused by extradural tophaceous deposits that had initially been diagnosed as lymphoid malignancy.

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“…Apesar de a prevalência da gota ser relativamente alta, o acometimento axial é um evento raro. Todos os segmentos da coluna vertebral, de C1 a S1, podem ser atingidos (1,4) , sendo mais rara na coluna torácica, havendo apenas 17 casos descritos nesse local (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) .…”

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“…Thus, although tophi rarely affect the spinal cord, they should be considered as a possibility in cases of spinal cord compression syndrome in patients with a history of gout.A gota é uma doença metabólica na qual ocorre hiperprodução e/ou diminuição da excreção de ácido úrico, levando à deposição de cristais de monourato de sódio nas articulações e tecidos moles. O acometimento axial é raro, havendo apenas 73 casos descritos na literatura médica (1,2) , sendo 17 na coluna torácica (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) . Relatamos um caso de paraplegia aguda decorrente de compressão medular por tofo gotoso.…”

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Paraplegia aguda por compressão da medula espinhal torácica causada por tofo gotoso

Hasegawa

Goldeinstein-Schainberg

Fuller

2007

Rev. Bras. Reumatol.

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RESUMOO acometimento axial pela gota é um evento raro, e o envolvimento da coluna torácica foi descrito em apenas 17 casos na literatura. Apresentamos um caso de paciente do sexo masculino de 48 anos com história de gota, sob tratamento irregular com alopurinol e colchicina, que desenvolveu paraplegia aguda decorrente de compressão medular por tofo gotoso. Realizouse o diagnóstico por meio de ressonância magnética e anatomia patológica. Foi tratado com antiinflamatórios e descompressão cirúrgica com melhora importante, porém parcial. Apesar de o acometimento medular pelo tofo ser um evento raro, deve ser considerado nos casos de síndrome de compressão medular em pacientes com antecedente de gota. ABSTRACTAxial gout is a rare condition and the involvement of the thoracic spine has been described only 17 times in the literature. This paper presents the case of a 48 year-old male patient with a history of gout, under irregular treatment with allopurinol and colchicines, who developed acute paraplegia resulting from spinal cord compression by tophaceous gout. The diagnosis was made using magnetic resonance imaging and anatomic pathology. The patient was treated with anti-inflammatory drugs and surgical decompression and showed important, albeit partial, improvement. Thus, although tophi rarely affect the spinal cord, they should be considered as a possibility in cases of spinal cord compression syndrome in patients with a history of gout.A gota é uma doença metabólica na qual ocorre hiperprodução e/ou diminuição da excreção de ácido úrico, levando à deposição de cristais de monourato de sódio nas articulações e tecidos moles. O acometimento axial é raro, havendo apenas 73 casos descritos na literatura médica (1,2) , sendo 17 na coluna torácica (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) . Relatamos um caso de paraplegia aguda decorrente de compressão medular por tofo gotoso. RELATO DE CASOPaciente masculino de 48 anos com história de gota tofácea há 10 anos, fazendo tratamento irregular com colchicina e alopurinol. Apresentou quadro agudo de fraqueza nos membros inferiores em dezembro de 2004 sem história de trauma, emagrecimento ou febre. Desenvolveu paraplegia crural após 4 dias, com nível sensitivo em T7 e diminuição dos reflexos aquíleo e plantar bilateralmente.O ácido úrico foi de 8,2 mg/dl. A pesquisa para afecções virais e sífilis foram negativas, com hemograma normal, velocidade de hemossedimentação de 48 mm e RX de tórax normal.A pesquisa direta no liquor foi negativa para bactérias, fungos e bacilos álcool-ácido resistentes; os demais parâmetros do liquor foram normais.A radiografia da coluna foi normal. A ressonância magnética evidenciou uma formação perimedular na projeção epidural posterior em T7 e T8 com hipossinal em T1 e hipersinal em T2 (Figura 1), com insinuação para o recesso neural esquerdo.

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Thoracic Myelopathy Due to Compression by the Epidural Tophus

Cited by 17 publications

References 0 publications

Spinal Gout

Spinal Gout

Thoracic spinal cord compression by extradural tophus: a case report and review of the literature

Paraplegia aguda por compressão da medula espinhal torácica causada por tofo gotoso

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