Turkish Neurosurgery 2015 , Vol 25 , Num 6
Tophaceous Gout of the Lumbar Spine: Case Report and Review of the Literature
Andrey VOLKOV1, David L. RHOINEY2, Roderick CLAYBROOKS3
1Providence Hospital and Medical Center, St. John Health System, Department of Neurosurgery, Southfield, MI, USA
2A.T. Still University-Kirksville College of Osteopathic Medicine, Clinical Affairs, Kirksville, MO, USA
3Providence Hospital and Medical Center, St. John Health System, Southfield, MI, USA
DOI : 10.5137/1019-5149.JTN.11612-14.1 Tophaceous gout has classically been described as an affliction of the extremities. It has however been reported as early as 1947 to involve the spinal column. We report a 63-year-old male, previously scheduled for Anterior Cervical Discectomy and Fusion to correct an existing cervical myelopathy at the C3-C4 spinal level, who presented to the emergency room with progressive weakness of the lower extremities and inability to ambulate for three days. Physical examination suggested a possible worsening of his cervical myelopathy but magnetic resonance imaging (MRI) findings remained unchanged from comparison studies. On the day of surgery, he became febrile and complained of excruciating back pain and we therefore initiated an infectious etiology workup and obtained a lumbar spine MRI. Results of imaging suggested a lumbar epidural abscess with effacement of the thecal sac. Emergent L4-L5 decompression led to an evacuation of a “chalky” substance, which was sent for pathology evaluation. This patient was diagnosed with tophaceous gout of the lumbar spine upon final pathological review. We aim to present the management of this case and review the literature associated with this diagnosis with the goal of improving the approach taken to diagnose and treat this pathology. Keywords : Epidural abscess, Spinal gout, Spinal stenosis, Tophaceous gout, Spinal infection
Corresponding author : David L. Rhoney, drhoiney@atsu.edu