Abstract
Study design:Here we describe a patient who developed myelopathy due to gouty tophi of the ligamentum flavum in the thoracic spine. We also review similar cases previously reported in the literature.Objective:Our aim was to present a case of myelopathy due to thoracic spinal gouty tophus.Methods:We report the case of a 56-year-old male with history of peripheral gout and renal insufficiency. The patient complained of back pain and paraparesis of the left lower limb. Multiple tophi were noted over several interphalangeal and metatarsophalangeal joints. Neurological examination showed decreased left lower limb strength and a positive Babinski sign. Magnetic resonance imaging of the thoracic spine revealed hypertrophy of the ligamentum flavum at the level of T3/T4, T5/T6, T9/T10, T10/T11 and T11/T12.Results:A thoracic laminectomy at T1-T5 was performed. Chalky white granular material was found in the ligamentum flavum during surgery. Histological analysis of the specimen demonstrated a gouty tophus. The patient's back pain and paraparesis of the lower left limb improved.Conclusion:The clinician should include spinal gout in the differential diagnosis when dealing with patients with gout and axial pain with or without neurologic deficits. If this diagnosis is seriously entertained, then a CT scan or magnetic resonance imaging as well as tissue biopsy may be needed to establish the diagnosis.
Highlights
Gout is monosodium urate crystal-induced inflammatory arthritis associated with hyperuricemia.[1]
Our aim was to present a case of myelopathy due to thoracic spinal gouty tophus
We report the case of a 56-year-old male with history of peripheral gout and renal insufficiency
Summary
Gout is monosodium urate crystal-induced inflammatory arthritis associated with hyperuricemia.[1] The incidence of gout is estimated to be 0.2–0.4% worldwide, with an annual incidence of 0.01–0.015%.2. Gout is more common in men with a male-to-female ratio of 4:1 below the age of 65 years and 3:1 above the age of 65 years.[3] Predisposing factors for an acute attack include trauma, surgery, increasing alcohol intake, high levels of intake of meat and fish and medications including diuretics and cyclosporine. Tophaceous gout is characterized by precipitation of urate crystals in the joints and periarticular tissues, and deposits commonly are found in the metatarsophalangeal joints, ankles, knees, wrists, fingers and shoulders. Gouty arthritis of the axial joints, of the spine, is very rare
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