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Cotten A, Henry S, Scarciolla L, Abou Diwan R, Demondion X, Badr S. Crystal Diseases of the Spine. Semin Musculoskelet Radiol 2023; 27:545-552. [PMID: 37816362 DOI: 10.1055/s-0043-1770763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
Gout, calcium pyrophosphate deposition disease, and apatite calcifications, the three main crystal disorders, may involve the spine. These disorders can be completely asymptomatic or associated with various clinical symptoms, such as acute flares and more chronic manifestations. This article presents the typical and more unusual imaging features encountered in these disorders.
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Affiliation(s)
- Anne Cotten
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
- University of Lille, MABlab ULR 4490, Lille, France
| | - Simon Henry
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
| | - Laura Scarciolla
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
| | - Ralph Abou Diwan
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
| | - Xavier Demondion
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
- University of Lille, CHU Lille, Unité de Taphonomie Médicolégale & d'Anatomie, Lille, France
| | - Sammy Badr
- CHU Lille, Service de Radiologie et Imagerie Musculosquelettique, Lille, France
- University of Lille, MABlab ULR 4490, Lille, France
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2
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Jazaib Ali MY, Hussain M. Case of lumbar spinal stenosis and chronic tophaceous gout. Surg Neurol Int 2023; 14:294. [PMID: 37680922 PMCID: PMC10481838 DOI: 10.25259/sni_504_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023] Open
Abstract
Background Rarely, chronic tophaceous gout can result in lumbar spinal stenosis and neural compression. Case Description A 67-year-old male presented with the radiographic and magnetic resonance findings of gout involving and causing compression of the lumbar spine that responded to surgical decompression. Conclusion It is difficult to diagnose lumbar spinal stenosis secondary to tophaceous gout. Notably, the treatment, based on the clinical presentation, may include both medication and surgical decompression.
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3
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Zhou MMX, Wu MMM, Sang MML, Wu MMJ. Clinical observation of posterior decompression, fusion and fixation in the treatment of spinal gout: a case series. J Orthop Surg Res 2023; 18:303. [PMID: 37061710 PMCID: PMC10105939 DOI: 10.1186/s13018-023-03791-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/10/2023] [Indexed: 04/17/2023] Open
Abstract
OBJECTIVE The aim of the present study was to assess the effect of posterior decompression, fusion and fixation in the treatment of spinal gout. Spinal gout is a disease of gouty arthritis involving the spine, which can affect all segments of the spine. At present, the etiology and pathogenesis of spinal gout are not clear, and there are no definite methods for the treatment of spinal gout. METHODS This was a case series of seven patients (seven men) who underwent posterior decompression, fusion and fixation in the treatment of spinal gout between January 2016 and January 2020. Physical examination, radiography, CT, MRI, Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) score were used to evaluate the effect of this procedure. All patients were followed up every 3 months. The evaluation time point was 12 months after the operation. Comparisons of the functional indexes of the patients before and after the operation were performed using SPSS 22.0 (IBM, Armonk, NY, USA). RESULTS The JOA score was 13.43 ± 6.55 and the VAS score was 7.43 ± 1.51 preoperatively. The JOA score was 24.43 ± 3.74 and the VAS score was 0.86 ± 0.90 postoperatively at 12 months after surgery. At 12 months after surgery, the JOA and VAS score showed significant improvements when compared with those before surgery (P = 0.004 and P = 0.002, respectively). None of the patients had re-surgery of the gout due to actively and reasonably controlling uric acid. No loosening or displacement of screws was reported. There was only one screw tail cap loosening. Radiographic examination revealed that there was no obvious accumulation of gout or surrounding bone destruction, and the segmental instability was significantly improved. There was no progressive aggravation of neurological symptoms of the seven patients. CONCLUSIONS Posterior approach decompression, fusion and fixation can stabilize the vertebral body, remove gout and directly relieve local spinal cord compression. The method is a reliable surgical choice for the treatment of spinal gout.
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Affiliation(s)
- M M Xingmao Zhou
- Department of Orthopaedic Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan City, 528400, Guangdong Province, People's Republic of China
| | - M M Minhua Wu
- Department of Orthopaedic Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan City, 528400, Guangdong Province, People's Republic of China
| | - M M Lili Sang
- Department of Orthopaedic Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan City, 528400, Guangdong Province, People's Republic of China.
- Division of Spine Surgery, Department of Orthopaedic Surgery, Zhongshan Hospital of Traditional Chinese Medicine, No. 3, Kangxin Road, West District, Zhongshan City, 528400, Guangdong Province, People's Republic of China.
| | - M M Junzhe Wu
- Department of Orthopaedic Surgery, Zhongshan Hospital of Traditional Chinese Medicine, Zhongshan City, 528400, Guangdong Province, People's Republic of China
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4
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Boudabbous S, Paulin EN, Delattre BMA, Hamard M, Vargas MI. Spinal disorders mimicking infection. Insights Imaging 2021; 12:176. [PMID: 34862958 PMCID: PMC8643376 DOI: 10.1186/s13244-021-01103-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 10/03/2021] [Indexed: 12/23/2022] Open
Abstract
Spinal infections are very commonly encountered by radiologists in their routine clinical practice. In case of typical MRI features, the diagnosis is relatively easy to interpret, all the more so if the clinical and laboratory findings are in agreement with the radiological findings. In many cases, the radiologist is able to make the right diagnosis, thereby avoiding a disco-vertebral biopsy, which is technically challenging and associated with a risk of negative results. However, several diseases mimic similar patterns, such as degenerative changes (Modic) and crystal-induced discopathy. Differentiation between these diagnoses relies on imaging changes in endplate contours as well as in disc signal. This review sought to illustrate the imaging pattern of spinal diseases mimicking an infection and to define characteristic MRI and CT patterns allowing to distinguish between these different disco-vertebral disorders. The contribution of advanced techniques, such as DWI and dual-energy CT (DECT) is also discussed.
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Affiliation(s)
- Sana Boudabbous
- Division of Radiology, Department of Diagnosis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland. .,Faculty of Medicine of the Geneva University, Geneva, Switzerland.
| | - Emilie Nicodème Paulin
- Division of Radiology, Medical Imaging Department, Hospital of Neuchatel, Neuchâtel, Switzerland
| | - Bénédicte Marie Anne Delattre
- Division of Radiology, Department of Diagnosis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland.,Faculty of Medicine of the Geneva University, Geneva, Switzerland
| | - Marion Hamard
- Division of Radiology, Department of Diagnosis, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva 14, Switzerland
| | - Maria Isabel Vargas
- Faculty of Medicine of the Geneva University, Geneva, Switzerland.,Division of Neuroradiology, Diagnostic Department, University Hospitals of Geneva, Geneva, Switzerland
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5
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Thompson JW, Srinivasan S, Makkuni D. Chronic tophaceous gout mimicking widespread metastasis. BMJ Case Rep 2021; 14:14/5/e236166. [PMID: 34059531 DOI: 10.1136/bcr-2020-236166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Gout is a common crystal-induced arthropathy affecting mainly the joints of the appendicular skeleton; however, rarely this condition affects the axial skeleton as well. Spinal gout can cause radiculopathy, cord compression, canal stenosis and discitis. We describe a case of a 71-year-old woman where the initial presentation of destructive arthropathy and spinal masses secondary to axial gout was mistaken for a metastatic malignancy. Despite chronic polyarthropathy and bilateral subcutaneous gouty tophi, spinal gout was not considered a differential diagnosis during initial assessment.The patient was managed conservatively with pharmacological treatment resulting in improvement of her upper limb radiculopathy and systemic joint pain, although little improvement in mobility. Such extensive involvement is rare and the masses can mimic an underlying metastatic disease. Careful history and clinical examination recognising polyarthropathy and subcutaneous tophi can aid the clinician to make the right diagnosis and institute correct treatment. Delay in recognising gout as a differential diagnosis can lead to marked morbidity as illustrated in our case.
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Affiliation(s)
- Joshua W Thompson
- Trauma & Orthopaedics, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Sriram Srinivasan
- Trauma & Orthopaedics, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Damodar Makkuni
- Rheumatology Department, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
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6
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Romero AB, Johnson EP, Kirkpatrick JS. Tophaceous gout of the atlantoaxial joint: a case report. J Med Case Rep 2021; 15:74. [PMID: 33588945 PMCID: PMC7885401 DOI: 10.1186/s13256-020-02638-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background To report the occurrence of tophaceous gout in the cervical spine and to review the literature on spinal gout. Case presentation This report details the occurrence of a large and clinically significant finding of tophaceous gout in the atlantoaxial joint of the cervical spine in an 82-year-old Caucasian man with a 40-year history of crystal-proven gout and a 3-month history of new-onset progressive myelopathy. The patient's American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria score was 15.0. Conclusion Spinal gout is more common than previously thought, and it should be considered in patients who present with symptoms of myelopathy. Diagnosis can be made without a tissue sample of the affected joint(s) with tools like the ACR/EULAR criteria and the use of the “diagnostic clinical rule” for determining the likelihood of gout. Early conservative management with neck immobilization and medical management can avoid the need for surgical intervention.
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Affiliation(s)
- Andrew Benjamin Romero
- Department of Orthopaedic Surgery, Orlando VA Medical Center, Orlando, FL, 32827, USA. .,University of Central Florida College of Medicine, 13025 Cordelia Lane, Apt 301, Orlando, FL, 32824, USA.
| | - Evan Paul Johnson
- University of Central Florida College of Medicine, 13025 Cordelia Lane, Apt 301, Orlando, FL, 32824, USA
| | - John S Kirkpatrick
- Department of Orthopaedic Surgery, Orlando VA Medical Center, Orlando, FL, 32827, USA.,University of Central Florida College of Medicine, 13025 Cordelia Lane, Apt 301, Orlando, FL, 32824, USA
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Ayoub S, Rajamohan AG, Acharya J, Gross J, Patel V. Chronic tophaceous gout causing lumbar spinal stenosis. Radiol Case Rep 2020; 16:237-240. [PMID: 33304433 PMCID: PMC7708751 DOI: 10.1016/j.radcr.2020.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 11/11/2020] [Indexed: 12/23/2022] Open
Abstract
Gout is a common cause of inflammatory arthritis, typically affecting the joints of the appendicular skeleton. In this report, we present the relatively less common scenario of chronic tophaceous gout affecting the lumbar spine and pelvis, complicated by compressive neuropathy, and notable for its advanced initial presentation in a young patient. We review the pathophysiology underlying gout and discuss its clinical and laboratory presentation. We also use our case as an example to present the radiographic, CT, and MR imaging features of gout affecting the lumbar spine, which can often present a diagnostic dilemma. Finally, we discuss therapeutic options for gout resulting in spinal canal compromise, which include interventions not commonly performed for gout elsewhere in the body.
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Affiliation(s)
- Samantha Ayoub
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anandh G. Rajamohan
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jay Acharya
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jordan Gross
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Vishal Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Corresponding author.
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Carcione J, Bodofsky S, LaMoreaux B, Schlesinger N. Beyond Medical Treatment: Surgical Treatment of Gout. Curr Rheumatol Rep 2020; 23:1. [PMID: 33236200 DOI: 10.1007/s11926-020-00969-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Medical treatment with urate-lowering therapy (ULT) is efficacious. A recent publication suggested that surgery in gout is more prevalent than previously reported. This revelation led us to review what is known about surgical treatment of gout. RECENT FINDINGS The Google Scholar database (January 1, 2014-January 1, 2020) found 104 publications with a total of 169 gout patients, with an average disease duration of 6.7 years. Most (68%) were not on ULT. The mean pre-operative serum urate levels were 9.19 mg/dL. One hundred thirteen patients underwent tophi excision, while in 33 patients, tophi were found during surgery. The majority of the surgeries were performed in Asia and Europe. Most patients were not taking ULT at the time of surgery, leading to hyperuricemia. This can result in tophi reformation post-surgery. The role of surgery should be a last-line treatment and until recently has only been demonstrated through case reports.
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Affiliation(s)
| | - Shari Bodofsky
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | - Naomi Schlesinger
- Division of Rheumatology, Department of Medicine, Rutgers Robert Wood Johnson Medical School Gout Center, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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9
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Kao Y, Wang Z, Leng J, Qu Z, Zhuang X, Ma H, Song Q, Liu Z, Sun S, Liu Y. Thoracic gout tophus with abdominal wall protrusion: A case report. Medicine (Baltimore) 2020; 99:e19348. [PMID: 32150074 PMCID: PMC7478684 DOI: 10.1097/md.0000000000019348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE A patient presented the abdominal wall protrusion due to tophaceous gout of the spine. Similar cases were not reported in the literature. This study aimed to report a case of tophaceous gout of the spine with abdominal wall protrusion. PATIENT CONCERNS A 38-year-old male patient had a 10-year history of gout and hyperuricemia. He complained of back pain and abdominal wall protrusion. DIAGNOSES The patient was diagnosed with tophaceous gout of the spine with abdominal wall weakness caused by T11 nerve root compression. INTERVENTIONS A semi-lamina decompression was performed at T11-T12. The pathological examination of the specimen demonstrated tophaceous gout of the spine. OUTCOMES After the surgery, the patient's back pain was completely relieved and the abdominal wall weakness significant improved. LESSONS This case highlighted that axial gout could mimic thoracic disk herniation clinically. The abdominal wall weakness might also be due to single T11 nerve compression by the tophaceous gout of the spine. In patients with a history of gout, axial gout should be considered as one of the differential diagnoses.
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Affiliation(s)
| | | | - Jiali Leng
- Department of Hospice, the First Hospital of Jilin University, No. 1, Xinmin St, Chaoyang District, ChangChun City, Jilin Province
| | | | | | - Hongyun Ma
- Department of Orthopaedics, Qinghai Provincial People's Hospital, Xining City, Qinghai Province
| | | | - Zijing Liu
- Nursing platform of spinal surgery department, the First Hospital of Jilin University, No. 1, Xinmin St, Chaoyang District, ChangChun City, Jilin Province, People's Republic of China
| | | | - Yi Liu
- Department of Spinal Surgery
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10
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Browne C, Mutsaers A, Fisher B. A Case of Mistaken Identity: Paget's Disease of the Bone Causing Cord Compression—Case Report and Review of the Literature. Pract Radiat Oncol 2019; 9:e613-e619. [DOI: 10.1016/j.prro.2019.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 06/09/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
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Abstract
RATIONALE Cervical ligamentum flavum gout (CLFG) is relatively rare, and its clinical manifestations are complicated; hence, it is often confused with ligamentum flavum ossification. Gout tophi may relate to certain risk factors, such as renal insufficiency and lack of long-term effective uric acid treatment. PATIENT CONCERNS A 73-year-old man had a half-year history of left upper extremity pain and numbness, which was aggravated 6 months ago. DIAGNOSES Computed tomography (CT) indicated spinal stenosis at the level of C5/6. Cervical stenosis was believed to be mostly related to the ossification of ligamentum flavum. The histological examination of the material removed during the surgery revealed fibrous tissues with pools of amorphous debris having a foreign body giant cell reaction, which is typical of urate gout. INTERVENTIONS We performed complete decompressions for this case with CLFG using posterior percutaneous endoscopic technique. OUTCOMES The patient experienced a progressive improvement in the left upper extremity pain after the surgery, and no signs of cerebrospinal fluid leakage, infection, or other complications were experienced. LESSONS The clinician should include spinal gout in the differential diagnosis when dealing with patients with hyperuricemia, renal insufficiency, and axial pain with or without neurologic deficits. We have applied the percutaneous endoscopic technique for the treatment of spinal gout. It performed direct decompression with minimizing trauma and instability, which could be used as an alternative choice.
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Affiliation(s)
- Lin Xie
- Department of Spine Surgery, Third Clinical Medical College of Nanjing University of Chinese Medicine
- Department of Orthopedic Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, Jiangsu, China
| | - Xiang Zhang
- Department of Orthopedic Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, Jiangsu, China
| | - Zhipeng Xi
- Department of Spine Surgery, Third Clinical Medical College of Nanjing University of Chinese Medicine
- Department of Orthopedic Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, Jiangsu, China
| | - Jingchi Li
- Department of Spine Surgery, Third Clinical Medical College of Nanjing University of Chinese Medicine
- Department of Orthopedic Surgery, Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, Jiangsu, China
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12
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Zhang T, Yang F, Li J, Pan Z. Gout of the axial joint—A patient level systemic review. Semin Arthritis Rheum 2019; 48:649-657. [DOI: 10.1016/j.semarthrit.2018.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 04/18/2018] [Accepted: 04/29/2018] [Indexed: 12/11/2022]
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13
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Cheng CW, Nguyen QT, Zhou H. Tophaceous gout of the cervical and thoracic spine with concomitant epidural infection. AME Case Rep 2018; 2:35. [PMID: 30264031 DOI: 10.21037/acr.2018.07.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 06/07/2018] [Indexed: 12/16/2022]
Abstract
Tophaceous gout of the spine is an underappreciated source of back pain in patients with or without neurological decline. It has been reported to occur in the cervical, thoracic and lumbar spine. Rarely, does it occur at more than one region of the spine. Advanced imaging with magnetic resonance imaging and computed tomography are usually not helpful in differentiating between infection, malignancy and gout. Clinician should have a high suspicion of spinal gout in patients with history of gout who presents with renal insufficiency, presence of peripheral tophi on exam, with elevated serum uric acid and creatinine levels, erythrocyte sedimentation rate and C-reactive protein. Here we present a case of a 23-year-old male with history of gout and chronic renal disease with progressive weakness in his lower extremities with new urinary incontinence who was found to have spinal gout with epidural infection of both the cervical and thoracic spine. Our patient was successfully managed with surgical decompression followed by medical treatment with antibiotics and steroids.
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Affiliation(s)
- Christina W Cheng
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, Seattle, Washington, USA
| | - Quynh T Nguyen
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, Seattle, Washington, USA.,Department of Radiology, Harborview Medical Center, Seattle, Washington, USA
| | - Haitao Zhou
- Department of Orthopaedics and Sports Medicine, Harborview Medical Center, Seattle, Washington, USA
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14
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Ding Y, Wang W, Jiang W, Zhang L, Wang T, Li Z. Tophaceous gout causing thoracic spinal cord compression: Case report and review of the literature. Neurochirurgie 2018; 64:171-176. [PMID: 29731313 DOI: 10.1016/j.neuchi.2017.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/19/2017] [Accepted: 11/05/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To improve neurologists' awareness of spine gout by showing a rare case of tophaceous gout in thoracic spine and a summary of vertebral gout in order. MATERIAL AND METHODS We reported a case of a 36-year-old male with a 2-year-history of hyperuricemia. Neurological examination suggested that the strength of his lower limbs decreased. Bilateral Babinski's sign and ankle clonus were positive. He had no bladder or bowel dysfunction. Computed tomography of the thoracic spine showed occupied lesions at the T9, T10 levels which led to the spinal stenosis. Magnetic resonance imaging of the thoracic spine revealed epidural disease at T9, T10 levels. A resection of the occupying lesion in the thoracic spinal canal was performed, tophaceous gout was diagnosed by the pathological examination. We also provide a brief review of literature on 30 cases of spine tophaceous gout. RESULT Spinal tophaceous gout is rare, gout can involved in any spine level, but the probability of occurrence of thoracic spine is the least. Most patients had a history of hyperuricemia or peripheral tophus, the most common symptoms are back pain, when the pain stone compression spinal cord or nerve root, there will be the corresponding neurological symptoms or signs. CONCLUSIONS The spinal gout should be considered when a patient has chronic or acute back pain and/or neurological symptoms, with mass on sides of the vertebras on MRI, especially when the patient has a history of hyperuricemia, the pathology examination can confirm the diagnosis.
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Affiliation(s)
- Y Ding
- Department of neurology, Xuanwu Hospital, Capital Medical University, 100053 Beijing, Republic of China.
| | - W Wang
- Department of pathology, Xuanwu Hospital, Capital Medical University, 100053 Beijing, Republic of China
| | - W Jiang
- Department of anatomy, histology and developmental biology, School of Basic Medical Sciences, Shenzhen University Health Science Centre, 518060 Shenzhen, Republic of China
| | - L Zhang
- Department of neurology, The Second Hospital of Hebei Medical University, 050000 Shijiazhuang, Republic of China
| | - T Wang
- Department of neurology, Xuanwu Hospital, Capital Medical University, 100053 Beijing, Republic of China
| | - Z Li
- Department of pathology, Xuanwu Hospital, Capital Medical University, 100053 Beijing, Republic of China
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15
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Abstract
STUDY DESIGN Case report. OBJECTIVE We report a case of a 16-year-old boy with intermittent and migratory polyarthralgia, who made a diagnostic dilemma. SUMMARY OF BACKGROUND DATA Spinal involvement without spinal symptom in gout seems to be rare. However, the relationship of spinal gout to symptoms is poorly understood. METHODS Description of the case report. RESULTS Laboratory findings cannot explain his symptoms; however, a computed tomography of the pelvis revealed the presence of space-occupying lesion involving the left side of spine at L5-S1 level, and the later biopsy revealed that was a urate crystal, which help us make the diagnosis of spinal gout. CONCLUSION Gout can be a cunning disease which has various manifestations, and spinal involvement can be asymptomatic. LEVEL OF EVIDENCE 5.
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16
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Vergara P, O'Donovan DG. Minimally Invasive Excision of Lumbar Tophaceous Gout: Case Report. Int J Spine Surg 2018; 11:37. [PMID: 29372141 DOI: 10.14444/4037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background Symptomatic spinal gout is relatively rare. Open laminectomy, with or without fusion, has been so far the standard treatment for symptomatic spinal gout. We describe here the first case of spinal tophaceus gout treated with minimally invasive surgery. Methods A 60-year-old patient, morbidly obese, with no previous history of gout, presented with neurogenic claudication due to severe lumbar canal stenosis at L3/4. Surgery was performed through a minimally invasive approach, using tubular retractors. During surgery, an extradural mass with a thin capsule and containing white "chalky" partially calcified material, slightly adherent to and compressing the theca, was removed. Results There were no intra- or perioperative complications. Surgery successfully improved the functional status, with a significant increase in walking distance and no residual leg pain or neurogenic claudication. Histopathology confirmed the diagnosis of spinal tophaceous gout. Conclusions/Level of evidence Although spinal gout is usually responsive to medical treatment, surgery is often the first line treatment, particularly in patients with neurological deficits. Would surgery be indicated, we believe that minimally invasive surgery can be effective in treating symptomatic spinal tophaceous gout. Level of Evidence: Class IV.
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Affiliation(s)
- Pierluigi Vergara
- Department of Neurosurgery, Addenbrooke's Hospital, Cambridge University Hospital, Cambridge, UK
| | - Dominic G O'Donovan
- Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospital, Cambridge, UK
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17
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Wang W, Li Q, Cai L, Liu W. Lumbar spinal stenosis attributable to tophaceous gout: case report and review of the literature. Ther Clin Risk Manag 2017; 13:1287-1293. [PMID: 29033576 PMCID: PMC5628693 DOI: 10.2147/tcrm.s145906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives Tophaceous 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. Methods We retrospectively reviewed a case of a patient with tophaceous gout of the lumbar spine and reviewed the relevant literature. Results A 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. Conclusion The 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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Affiliation(s)
- Wei Wang
- Department of Orthopaedics, Pu Ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Qingbo Li
- Department of Orthopaedics, Pu Ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Lei Cai
- Department of Orthopaedics, Pu Ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
| | - Weijun Liu
- Department of Orthopaedics, Pu Ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China
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Ragab G, Elshahaly M, Bardin T. Gout: An old disease in new perspective - A review. J Adv Res 2017; 8:495-511. [PMID: 28748116 PMCID: PMC5512152 DOI: 10.1016/j.jare.2017.04.008] [Citation(s) in RCA: 246] [Impact Index Per Article: 35.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/11/2017] [Accepted: 04/13/2017] [Indexed: 12/11/2022] Open
Abstract
Gout is a picturesque presentation of uric acid disturbance. It is the most well understood and described type of arthritis. Its epidemiology is studied. New insights into the pathophysiology of hyperuricemia and gouty arthritis; acute and chronic allow for an even better understanding of the disease. The role of genetic predisposition is becoming more evident. The clinical picture of gout is divided into asymptomatic hyperuricemia, acute gouty arthritis, intercritical period, and chronic tophaceous gout. Diagnosis is based on laboratory and radiological features. The gold standard of diagnosis is identification of characteristic MSU crystals in the synovial fluid using polarized light microscopy. Imaging modalities include conventional radiography, ultrasonography, conventional CT, Dual-Energy CT, Magnetic Resonance Imaging, nuclear scintigraphy, and positron emission tomography. There is remarkable progress in the application of ultrasonography and Dual-Energy CT which is bound to influence the diagnosis, staging, follow-up, and clinical research in the field. Management of gout includes management of flares, chronic gout and prevention of flares, as well as management of comorbidities. Newer drugs in the pharmacological armamentarium are proving successful and supplement older ones. Other important points in its management include patient education, diet and life style changes, as well as cessation of hyperuricemic drugs.
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Affiliation(s)
- Gaafar Ragab
- Rheumatology and Clinical Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Egypt
| | - Mohsen Elshahaly
- Rheumatology, Physical Medicine and Rehabilitation, Faculty of Medicine, Suez Canal University, Egypt
| | - Thomas Bardin
- Rhumatologie, Lariboisière Hospital, and Université Paris Diderot Sorbonne Cité, Paris, France
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Abstract
Gout is characterized by the deposition of monosodium urate crystals and by acute and chronic inflammation in response to crystals so deposited. Multiple case reports and series describe the deposition of monosodium urate in the spine as a rare manifestation of gout, but the actual prevalence of spinal involvement is unknown and likely to be higher than generally anticipated. Here we review the characteristics of 131 previously reported cases of spinal involvement in gout. We focus in particular on the use of imaging modalities and the extent to which they correlate with presenting symptoms and tissue diagnoses. The recent innovation of using dual-energy computerized tomography to identify urate crystal deposition holds promise for reducing the need for surgical intervention and for establishing a true prevalence rate for spinal gout.
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