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Case Reports
. 2023 Dec 18;27(2):66.
doi: 10.3892/etm.2023.12354. eCollection 2024 Feb.

Spinal gout with intervertebral foramen infiltration: A rare case perfectly mimicking degenerative lumbar disc disease

Fangke Hu  1 , Lu Xue  1 , Dong Zhao  1 , Chao Chen  1 , Gang Liu  1 , Qiang Yang  1
Affiliations
Case Reports

Spinal gout with intervertebral foramen infiltration: A rare case perfectly mimicking degenerative lumbar disc disease

Fangke Hu et al. Exp Ther Med. .

Abstract

Spinal gout is a relatively rare disease characterized by significant clinical symptoms. In the current study, the first case of spinal gout with tophus in the intervertebral foramen, which perfectly mimicked degenerative lumbar disc disorders, was presented. The patient was a 57-year-old man with a medical history of gout who had suffered from progressive neurological deterioration for the last 12 months. Imaging examination revealed bilateral stenosis in the L5/S1 intervertebral foramen, mimicking degenerative lumbar disc disease. Nerve root radiculography and blocking were performed and the neurological symptoms were completely relieved. Open surgery was further performed and unexpectedly, the intra-operative findings were amorphous chalky white lesions. Histopathology confirmed the diagnosis of spinal gout. After surgery, the patient was prescribed a medication and achieved complete remission of clinical symptoms. No deterioration was found at the 1-year follow-up. To the best of our knowledge, this is the first report of spinal gout tophus in intervertebral foramen in the literature. It was concluded that, although intraspinal tophaceous gout is relatively rare, orthopedic surgeons should take it into consideration as a differential diagnosis, particularly if the patient has a medical history of gout. Early diagnosis and timely medical management may possibly be able to avoid neurological compromise and the need for surgery.

Keywords: intervertebral foramen; spinal gout; tophaceous gout.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Representative palpable tophi in the extremities. (A) The left hand, (B) the right knee and (C) the right foot, with arrows indicating the tophi.
Figure 2
Figure 2
X-ray radiographs revealing degenerative features (vertebral hyperplasia, L5/S1 intervertebral space narrowing and degeneration of articular process joints) of the lumbar spine. (A) Anterior-posterior view; (B) lateral view.
Figure 3
Figure 3
MR scan revealing bilateral stenosis in the L5/S1 intervertebral foramen without any significant stenosis in the vertebral canal and lateral recess. (A) T2-weighted and (B) T1-weighted sagittal view showing no stenosis in the vertebral canal; T2-weighted sagittal view of the (C) left and (D) right showing stenosis in the L5/S1 intervertebral foramen (arrows); T2-weighted axial view showing the stenosis in the (E) right and (F) left L5/S1 intervertebral foramen (arrows).
Figure 4
Figure 4
CT scan revealing bilateral stenosis in the L5/S1 intervertebral foramen. (A) Bone window view and the arrow showed the gout infiltration; and (B) soft tissue window (the arrows indicate the gout infiltration).
Figure 5
Figure 5
Bilateral L5 nerve root radiculography. (A) Anterior-posterior view (the arrow shows the L5 nerve); and (B) lateral view.
Figure 6
Figure 6
Post-operative X-ray. (A) Anterior-posterior view; and (B) lateral view.
Figure 7
Figure 7
Pathological examination of spinal gout. (A) Gross appearance of amorphous chalky white lesions on the specimens (scale, 1 cm). (B) H&E staining photomicrograph (arrow indicates urate crystals surrounded by inflammatory cells; magnification, x100; scale bar, 100 µm); (C) H&E staining photomicrograph (arrow indicates the multinucleate foreign body-type giant cell; magnification, x400; scale bar, 25 µm); (D and E) Polarized light microscopy Nikon OCLIPSE 80i films showing the (D) positive vs. (E) negative birefringence of the needle-shaped urate crystals (magnification, x100; scale bar, 100 µm).
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Grants and funding

Funding: The present study was funded by the Tianjin Education Commission Research Project (grant no. 2022YGYB11).