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. 2023 Apr;67(1):50-66.

Spinal gout diagnosis in chiropractic practice: narrative review

Cameron I McConville  1 , James M Cox  2
Affiliations

Spinal gout diagnosis in chiropractic practice: narrative review

Cameron I McConville et al. J Can Chiropr Assoc. 2023 Apr.

Abstract
in English, French

Objective: To review and summarize the recent literature, increase awareness and provide guidance for chiropractic physicians regarding the diagnosis of spinal gout.

Methods: A search of PubMed was undertaken for recent case reports, reviews and trials relating to spinal gout.

Results: Our analysis of 38 cases of spinal gout revealed that 94% of spinal gout patients presented with back or neck pain, 86% displayed neurological symptoms, 72% had a history of gout, and 80% had raised serum uric acid levels. Seventy-six percent of cases proceeded to surgery. A combination of clinical findings, laboratory tests and appropriate utilization of Dual Energy Computed Tomography (DECT) has the potential to improve early diagnosis.

Conclusion: Gout is an uncommon cause of spine pain; however, it must be considered in the differential diagnosis as outlined in this paper. Increased awareness of the signs of spinal gout and earlier detection and treatment has the potential to improve the quality of life of patients and reduce the need for surgery.

Objectif: Examiner et résumer la littérature récente, sensibiliser les médecins chiropraticiens et les guider dans le diagnostic de la goutte spinale.

Méthodes: Une recherche a été entreprise dans PubMed pour trouver des rapports de cas, des études et des essais récents concernant la goutte spinale.

Résultats: Notre analyse de 38 cas de goutte spinale a révélé que 94 % des patients souffrant de goutte spinale présentaient des douleurs dorsales ou cervicales, 86 % des symptômes neurologiques, 72 % des antécédents de goutte et 80 % une élévation du taux d’acide urique sérique. Soixante-seize pour cent des cas ont donné lieu à une intervention chirurgicale. La combinaison des résultats cliniques, des tests de laboratoire et de l’utilisation appropriée de la tomographie informatisée à double énergie (DECT) peut améliorer les chances d’un diagnostic précoce.

Conclusion: La goutte est une cause peu fréquente de douleur vertébrale, mais elle doit être prise en compte dans le diagnostic différentiel, comme indiqué dans le présent document. Une meilleure connaissance des signes de la goutte spinale et une détection et un traitement plus précoces pourraient améliorer la qualité de vie des patients et réduire la nécessité d’une intervention chirurgicale.

Keywords: chiropractic; gout; spine.

PubMed Disclaimer

Conflict of interest statement

The authors have no disclaimers, competing interests, or sources of support or funding to report in the preparation of this manuscript.

Figures

Figure 1
Figure 1
Spinal gout imaging: x-ray, CT, MRI and histology of a 64-year-old male with an 11-month history of lower back pain and worsening left sided sciatica/leg weakness. (A) Lateral x-ray & (B)A-P x-ray show mild degenerative changes. (C) Axial CT shows left sided lateral recess stenosis at L4/5. (D) Sagittal MRI and (E) Axial MRI showing L4/5 disc herniation and left lateral recess narrowing. (F) Pathology examination revealing abundant MSU crystals surrounded by a foreign body-type giant cell reaction. Reprinted with permission (CC-BY): Chen et al. Percutaneous transforaminal endoscopic decompression for the treatment of intraspinal tophaceous gout: a case report. Medicine. 2020;99(21)
Figure 2
Figure 2
Spinal gout imaging: CT, MRI, DECT of a 32-year-old man with fever, acute severe lower back pain, history of left knee pain and gout.(a) A 32-yo man with probable gouty tophi affecting both hands (red arrows), (b) Axial MRI of his Lumbar spine (T2) reported as showing an abscess surrounding the right L4/5 facet joint (red arrow). (c) Axial CT of lumbar spine showing erosions (white arrow); and (d) corresponding DECT image (Siemens Somatom ForceTM) showing MSU crystal deposition (green). Reprinted with permission (CC-BY): Wang et al. The utility of dual energy computed tomography in the management of axial gout: case reports and literature review. BMC Rheumatol. 2020;4: 22.
Figure 3
Figure 3
Spinal gout imaging: CT, MRI and DECT of a 74-year-old male, six-week history of lower back pain and longstanding bilateral knee pain. (a) Axial CT showing right L4/5 facet joint erosion (white arrow) with calcified peri-articular mass encroaching on the lumbar canal (dashed white arrow) (b) Corresponding DECT image (Siemens Somatom ForceTM) showing MSU crystal deposition (green). (c) Sagittal T2-fat suppressed MRI image of the lumbar spine showing the soft tissue mass seen in (a) and (b) causing marked lumbar canal stenosis, and (d) corresponding DECT image showing attenuation consistent with MSU crystal deposition. Reprinted with permission (CC-BY): Wang et al. The utility of dual energy computed tomography in the management of axial gout: case reports and literature review. BMC Rheumatol. 2020;4:22.
Figure 4
Figure 4
Spinal gout imaging: DECT of a 67-year-old male patient presented with an exacerbation of acute-on-chronic lower back pain. Spinal urate deposits Lumbar spine DECT (A) Sagittal view (B) Coronary view (C) 3D rendered images showing urate deposits in facet joints (green). Reprinted with permission (CC-BY): Ahmad et al. Urate crystals; beyond joints. Front Med. 2021;8:649505.
Figure 5
Figure 5
Spinal gout imaging: MRI, CT and DECT of a 54-year-old with chronic lower back pain and a five-year history of gout. Presented to emergency with severe lower back pain and right buttock pain. Lumbar spine MRI and CT in axial gout. (A) Increased signal intensity on T2 weighted imaging of L4-5 and L5-S1. Intervertebral disc and erosive changes on the posterior cortices and endplates of L4-L5-S1 vertebra. (B) Enhancement of epidural space on T1WI. (C) Erosive changes in L4-5 and L5-S1 endplates on conventional CT. (D) MSU deposits (green) in the erosive foci of endplate on DECT. Reprinted with permission (CC BY): Jin et al. The frequency of axial deposition in Korean patients with gout at a tertiary spine center
Figure 6
Figure 6
Spinal gout: tophus removal. Intraoperative photograph taken by the surgical microscope showed a well-marked chalky white tophus lesion (arrow). Reprinted with permission (CC BY-NC 4.0): Elgafy et al. Spinal gout: a review with case illustration. World J Orthop. 2016;7(11): 766-775.
Figure 7
Figure 7
Spinal gout: proposed diagnostic / treatment algorithm
See this image and copyright information in PMC

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