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

Abstract

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.

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

“…The necropsy of that patient showed that the tophi had eroded the first cervical vertebrae causing a pathological fracture of the atlas with protrusion of the odontoid process into the foramen magnum. Since Kersley's original article, a few case reports of patients with spinal cord involvement caused by gout tophi have been published [5,6,[8][9][10][11][12][13][14][15][16].…”

“…In the vertebral column, gout tophi can affect different anatomical components, such as the articular facets, the vertebral bodies, the pedicles, the laminae, and the yellow ligaments. The lateral parts of the vertebra are usually more affected than the central areas [ 13 - 15 ]. The patient here described showed facet hypertrophy at the dorsal and lumbar levels with signs of spinal cord compression.…”

99mTc-methylene diphosphonate SPECT/CT imaging of gout spondylitis: a case report

“…To our knowledge, there have been few reports concerning the use of [ 99m Tc]-methylene diphosphonate (MDP) single-photon emission computed tomography (SPECT)/CT imaging to assess spinal tophi. [3][4][5][6] Here, we discuss the usefulness of [ 99m Tc]-MDP SPECT/CT imaging in the diagnosis of gout spondylitis.…”

Tophaceous gout of the cervical and thoracic spine with concomitant epidural infection

“…Kersley et al reported the first case of tophaceous gout of the spine in 1950 when he identified post-mortem tophaceous destruction of the upper cervical spine (5). Since then there have been multiple case reports of tophaceous gout in the cervical (6,7), thoracic (8)(9)(10) and lumbar spine (11)(12)(13)(14); with the lumbar spine being the most common site (2,3,14). There are currently only about three reports involving more than one region of the spine (1,6,15,16).…”

“…The presenting features of spinal gout include back pain (17), radiculopathy (11,12), myelopathic symptoms (10), paraparesis (8) or quadriplegia (6). In some cases, patients are asymptomatic and are not diagnosed until post-mortem (19,20).…”