Spinal Cord Compression Due to Tophaceous Vertebral Gout: A Case Report
By Admin | August 01, 2022
Abstract
Gout tophi are deposits of urate crystals in subcutaneous tissues and joints which commonly affect the small joints of the feet and hands, causing painful arthritis. The axial skeleton is considered to be seldom affected by gout arthritis. Here we describe the clinical, MRI, and pathologic findings of a 61-year-old male patient with a previous diagnosis of gout who presented with progressive paraparesis and radicular pain. MRI showed extradural masses compressing the spinal cord and roots at two spinal levels. Two surgical interventions were performed to remove these extradural masses, which were pathologically identified as gout tophi. Pain and paraparesis had clinical improvement after surgery. This report highlights that gout can be a cause of paraparesis.
Introduction
Gout is a metabolic disorder caused by the accumulation of uric acid in extracellular fluids [1,2]. Gout is estimated to affect one or two persons in every 1000 inhabitants [2]. Gout tophi are caused by the accumulation of monosodium urate crystals, surrounded by inflammatory cells and connective tissue, in several regions of the body [2]. Small joints and subcutaneous tissues are frequently affected, causing chronic joint pain [2]. On the other hand, the presence of gout tophi in axial joints is considered very rare and can produce neurological disorders [3]. In the vertebral column, the gout tophi can affect the joint facets, the vertebral bodies, the pedicles, and the flavum ligament [2-4]. There are just a few case reports about spinal cord disorders caused by the accumulation of monosodium urate crystals in the vertebral column joints. However, axial gout is likely more frequent than usually perceived [3,4]. Here we describe the clinical, MRI, and pathologic findings of a patient with gout and paraparesis caused by this unusual presentation of gout tophi.
Case Presentation
A 61-year-old male patient with a history of suffering from gout arthritis for 15 years attended the outpatient clinic of neurosurgery complaining of back pain and decreased muscle strength in both lower limbs for several months. The patient also had diabetes mellitus, arterial hypertension, and heart failure. He recognized that he was not following the diet recommendations or taking the medication (allopurinol, 200 mg per day) prescribed by his doctors to treat hyperuricemia. As a result, he had suffered from low back pain with paresthesia for five months and decreased muscle strength with spasticity in the lower extremities for two months, first in the...(More)
For more info please read, Spinal Cord Compression Due to Tophaceous Vertebral Gout: A Case Report, by Cureus
