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Nazwar TA, Bal’afif F, Wardhana DW, Panjaitan C. Understanding spinal gout: A comprehensive study of 88 cases and their clinical implications. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:133-140. [PMID: 38957764 PMCID: PMC11216640 DOI: 10.4103/jcvjs.jcvjs_166_23] [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: 11/28/2023] [Accepted: 02/23/2024] [Indexed: 07/04/2024] Open
Abstract
Background Spinal gout, a rare and often underdiagnosed condition, significantly impacts patients' quality of life. Therefore, the aim of the research is to analyze cases of spinal gout, including clinical features, anatomical location of spinal gout, laboratory studies, imaging studies, treatment choices, and outcomes from various cases of spinal gout. Methods The author conducted a systematic literature search in the PUBMED and Science Direct databases from 2013 to 2023. We included clinical case presentations of spinal cases in adults, published in English. The three researchers independently reviewed the title and abstract of each article, and any differences in opinions were resolved through consensus. The extracted data were subsequently analyzed descriptively. Results A total of 88 cases of spinal gout were obtained and studied. Out of the total reviewed cases of spinal gout, 89.77% of the subjects were male, with an average age of 51.9 years (age range 16-87 years). Common symptoms include back/neck pain (78.41%) and lower extremity weakness (37.50%). The lumbar spine is the most frequently affected region (62.50%), diagnosed primarily through magnetic resonance imaging (MRI) scans. Surgery, performed in 61.36% of cases, commonly involves decompressive laminectomy. Posttreatment, symptoms resolve in 87.50% of cases. Conclusion Cases of spinal gout present with a variety of symptoms, including back pain and weakness. Diagnosis typically involves an MRI examination and synovial fluid analysis for confirmation. Treatment varies and includes medication therapy and surgical interventions. A deeper understanding of these cases can assist healthcare practitioners in the management and diagnosis of spinal gout cases.
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Affiliation(s)
- Tommy Alfandy Nazwar
- Department of Surgery, Division of Neurosurgery, Brawijaya University/Saiful Anwar Hospital Malang, Malang, East Java, Indonesia
| | - Farhad Bal’afif
- Department of Surgery, Division of Neurosurgery, Brawijaya University/Saiful Anwar Hospital Malang, Malang, East Java, Indonesia
| | - Donny Wisnu Wardhana
- Department of Surgery, Division of Neurosurgery, Brawijaya University/Saiful Anwar Hospital Malang, Malang, East Java, Indonesia
| | - Christin Panjaitan
- Department of Surgery, Division of Neurosurgery, Brawijaya University/Saiful Anwar Hospital Malang, Malang, East Java, Indonesia
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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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Xu Q, Lin CS. An interesting tophus in gingiva. Int J Rheum Dis 2023; 26:401-402. [PMID: 36468714 DOI: 10.1111/1756-185x.14522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Qiang Xu
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Rheumatology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chang-Song Lin
- Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Rheumatology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Abreu Casas D, López-Piloto OR, Rodríguez de la Paz NJ, Plasencia-Leonardo JM, Íñiguez-Avendaño D, Gutierrez JV. Spinal Cord Compression Due to Tophaceous Vertebral Gout: A Case Report. Cureus 2022; 14:e27101. [PMID: 36000115 PMCID: PMC9391668 DOI: 10.7759/cureus.27101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/05/2022] Open
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Koro L, Khanna R, Richards D, Karahalios DG. Gout in the thoracic spine causing acute paraplegia: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 2:CASE21308. [PMID: 35854950 PMCID: PMC9265203 DOI: 10.3171/case21308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/01/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although spinal involvement by gout is not uncommon, spinal gout leading to symptomatic spinal cord compression in the thoracic spine is very rare and poses a diagnostic challenge by mimicking symptoms of more common diagnoses such as epidural abscess and malignancy. An even more unique presentation is spinal gout causing thoracic cord compression leading to acute paraplegia. OBSERVATIONS The authors present an illustrative case of a 35-year-old man with thoracic spinal compression by tophaceous gout who developed rapid progression to complete paraplegia over a 5-day period. Magnetic resonance imaging of the thoracic spine revealed a cystic-appearing lesion within the dorsal extradural space of the lower thoracic spine extending from T8 to T10 accompanied by compression of the spinal cord. An emergent T9–10 laminectomy was performed, and the occupying lesion in the thoracic spine was resected. The diagnosis of spinal tophaceous gout was made by pathological examination. LESSONS Although varying clinical manifestations of spinal gout have been reported in the literature, the patient’s age and the rapid progression to complete paraplegia over a 5-day period reveals a unique presentation that broadens understanding of the manner in which this condition can present and allow more rapid diagnosis and treatment.
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Affiliation(s)
- Lacin Koro
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois; and
| | - Ryan Khanna
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois; and
| | - Dominick Richards
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois; and
| | - Dean G. Karahalios
- Brain & Spine Institute, Advocate Aurora Health, Downers Grove, Illinois
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Filippucci E, Reginato AM, Thiele RG. Imaging of crystalline arthropathy in 2020. Best Pract Res Clin Rheumatol 2020; 34:101595. [PMID: 33012644 DOI: 10.1016/j.berh.2020.101595] [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] [Indexed: 12/14/2022]
Abstract
Crystal-related arthropathies are the result of crystal deposition in joint and periarticular soft tissues. Identification of urate crystals is mandatory to distinguish gout from other crystalline arthropathies, including calcium pyrophosphate dihydrate and basic calcium phosphate crystal deposition diseases. ACR/EULAR classification criteria for gout included dual-energy computed tomography and ultrasound with equal impact to the final score. Different diagnostic strengths of these imaging modalities depend on disease duration and scanned anatomic site. While ultrasound has been indicated as the first-choice imaging technique, especially in the early stages of the disease, dual-energy computed tomography has shown to be highly specific, allowing the detection of crystal deposits in anatomic sites not accessible by ultrasound, such as the spine. At the spinal level, MRI findings are usually nonspecific. Finally, there is preliminary evidence that at the knee, dual-energy computed tomography may discriminate calcium pyrophosphate dihydrate from basic calcium phosphate crystal deposits.
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Affiliation(s)
- Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, "Carlo Urbani" Hospital, Jesi, Ancona, Italy.
| | - Anthony M Reginato
- Division of Rheumatology, Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Ralf G Thiele
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, University of Rochester, Rochester, NY, USA.
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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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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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Liu Y, Li X, Jiao G, Zhou P, Li Z. Multilevel Lumbar Stenosis Caused by Large Tophi Involving Both Spinal Canal and Posterior Spinal Elements: A Rare Case Report and Literature Review. J Med Cases 2019; 10:333-337. [PMID: 34434303 PMCID: PMC8383701 DOI: 10.14740/jmc3392] [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: 11/12/2019] [Accepted: 11/20/2019] [Indexed: 11/27/2022] Open
Abstract
Tophus is a characteristic manifestation of gout entering the chronic phase, which usually deposits in the joints of the extremities, skin mucosa, etc. A gout tophus that involves the spine causing spinal stenosis is rare and it can be misdiagnosed as a spinal tumor preoperatively. We report the case of a 35-year-old man who presented with lumbar stenosis symptoms, and suffered multiple-site gout tophi involvement throughout his body. Radiographic examinations showed that the large tophi infiltrated the posterior elements of the spine and encroached the lumbar spinal canal, resulting in neurologic compression from the second to the fifth lumbar level. Urate could be observed on a dual-energy computed tomography. A posterior-based procedure was performed to eradicate the tophi and stabilize the spine. Finally, urate crystal was confirmed by postoperative pathological examination. Here, the clinical manifestations, radiological, pathological and surgical features for this case are reported.
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Affiliation(s)
- Yang Liu
- Department of Spinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou City, Guangdong Province, China
| | - Xueshi Li
- Department of Spinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou City, Guangdong Province, China
| | - Genlong Jiao
- Department of Spinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou City, Guangdong Province, China
| | - Pan Zhou
- Department of Spinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou City, Guangdong Province, China
| | - Zhizhong Li
- Department of Spinal Surgery, The First Affiliated Hospital of Jinan University, Guangzhou City, Guangdong Province, China
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Moscote-Salazar LR, Herrera-Martineza M, Pacheco-Hernandeza A, Narvaez-Rojas A. Letter to the editor regarding: "Tophaceous gout causing thoracic spinal cord compression: Case report and review of the literature". Neurochirurgie 2018; 65:52. [PMID: 30554775 DOI: 10.1016/j.neuchi.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/10/2018] [Accepted: 10/21/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - A Narvaez-Rojas
- Universidad Nacional Autonoma de Nicaragua, Managua, Nicaragua
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