Tophaceous Gout in the Cervical Spine

Yamamoto, Motohisa; Tabeya, Tetsuya; Masaki, Yoshiharu; Suzuki, Chisako; Naishiro, Yasuyoshi; Ishigami, Keiichi; Yajima, Hidetaka; Shimizu, Yoshitaka; Obara, Mikiko; Yamamoto, Hiroyuki; Sugaya, Toshiaki; Takahashi, Hiroki; Imai, Kohzoh; Shinomura, Yasuhisa

doi:10.2169/internalmedicine.51.6262

Cited by 14 publications

(7 citation statements)

References 18 publications

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“…WBC count, serum CRP level, and ESR are not specific in spinal gout, but elevated levels of serum uric acid are known to positively contribute to the development of spinal gout. [14,15] In our study, only 2 patients had leukocytosis and elevated serum CRP levels, whereas all of the patients had elevated serum uric acid levels and ESR. Therefore, the possibility of spinal gout should be considered when a patient presents with a history of gout or elevated uric acid level along with axial pain, radicular pain, or myelopathy.…”

Section: Discussionmentioning

confidence: 47%

Diagnostic challenges of spinal gout

Zhao

Jiang

et al. 2019

Medicine

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Introduction: Spinal gout is rarely encountered in clinical practice, is easily misdiagnosed, and often remains undiagnosed. This paper aims to provide some clues that are the salient diagnostic features of spinal gout, particularly axial pain, radiculopathy, and myelopathy, as determined on the basis of our experience with a few cases as well as a literature review. Methods: We retrospectively reviewed the clinical data of 5 patients that were treated for axial pain and neurological symptoms associated with spinal gout between 2014 and 2017 in our hospital. Herein, we systematically describe the clinical characteristics of 5 patients with spinal gout. The 5 patients included 4 men and 1 woman, aged between 24 and 75 years. The most common clinical presentation included spinal pain, radiculopathy, and myelopathy. Four of the 5 patients had a history of gout and elevated serum uric acid levels. Results: Four patients underwent surgery, while the remaining patient underwent conservative treatment and biopsy due to poor general condition. Pathological examination of the surgical samples in the 4 surgical cases and the biopsy sample in the remaining case confirmed the presence of spinal gout tophi. The neurological symptoms of all 5 patients were relieved after treatment. Conclusion: Due to its rarity and lack of typical defining criteria, the diagnosis of spinal gout is quite difficult. We recommend that patients presenting with axial pain; radicular pain or myelopathy; and especially high uric acid levels, with or without a history of gout, should be evaluated for spinal gout. Timely pathological examination of surgical or biopsy samples would help confirm the diagnosis and enable practitioners to provide the appropriate treatment to prevent disease progression.

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Section: Discussionmentioning

confidence: 47%

Diagnostic challenges of spinal gout

Zhao

Jiang

et al. 2019

Medicine

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“… 12 , 15 , 21 Other CT findings include degenerative changes, lytic lesions, and spinal stenosis. 22 – 25 We found that it was not easy to diagnose this disease radiographically. Are there any imaging methods with high specificity and accuracy to diagnose spinal tophaceous gout?…”

Section: Discussionmentioning

confidence: 97%

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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“…Preoperatively, pharmaceutical treatment was given to relieve pain, nourish nerve and dehydrate [1]. To immediately decompress the nerve root symptoms, surgical treatment including anterior cervical corpectomy, debridement and fusion, and internal fixation of C5–6 was performed [1, 8, 11]. After surgery, the muscle strengths of limbs were significantly improved.…”

Section: Case Presentationmentioning

confidence: 99%

Gout involved the cervical disc and adjacent vertebral endplates misdiagnosed infectious spondylodiscitis on imaging: case report and literature review

Zhou

Xiao

Liu

et al. 2019

BMC Musculoskelet Disord

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Background Gout in spine is rare and commonly mimics some infectious or tumoral lesions, the differentiation of spinal gout from other diseases is not always easy. We report a case of gout involved cervical disc and adjacent vertebral endplates whose etiology was initially not determined. Compared with the previous published 10 similar cases, this case displayed a complete and continuous image data with higher image quality and resolution than before. So we give a brief literature review for concerning cervical gout, with the emphasis on the discussion of radiological findings. Case presentation A 50-year-old male with a 5-year history of neck and shoulder pain had muscle atrophy and weakness in both arms. Physical examination revealed multiple tophi were seen in left wrist, both feet and knee; bilateral superficial sensory declined below level of mastoid portion and the muscle strengths of limbs decreased. Laboratory findings showed hyperuricemia and the C-reactive protein level was very high. Imaging studies including Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) showed abnormality of the C5–6 intervertebral disc and irregular osteolytic destruction of both adjacent C5–6 endplates, narrowing of C5–6 disc space and swelling of prevertebral soft tissue. Under the circumstance of the lesions being not determined and nerve root symptoms, surgical treatment was performed and pathological examination of the specimen revealed deposited uric acid crystals surrounded by granulomatous inflammation. After surgery combined with pharmaceutical and rehabilitation treatment, the muscle strengths of limbs, the pain of neck and shoulder and the level of serum uric acid were all improved. Conclusions Cervical spinal gout involving the disc and adjacent vertebral endplates is uncommon and may misunderstand infectious spondylodiscitis. Physician and radiologist should take the gouty spondylitis into account with a combination with previous history and clinical manifestations when encountering with such this condition.

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Tophaceous Gout in the Cervical Spine

Cited by 14 publications

References 18 publications

Diagnostic challenges of spinal gout

Diagnostic challenges of spinal gout

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

Gout involved the cervical disc and adjacent vertebral endplates misdiagnosed infectious spondylodiscitis on imaging: case report and literature review

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