Extradural spinal depositions of urates producing paraplegia

Litvak, John; Briney, Walter G.

doi:10.3171/jns.1973.39.5.0656

Cited by 29 publications

(9 citation statements)

References 3 publications

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“…5,6,[15][16][17] In the lumbar area, the most frequently affected (25 cases), the radicular compression is linked to the massive infiltration of the ligaments by the gouty tophi. 2,3,8,20 In the patients with sacroiliac gout, deposits of urate crystals were found in the hyaline cartilage within the articular space and adjacent bone. 36 Plain radiographs of the spine in gout could be normal or could show nonspecific degenerative changes or vertebral end-plate erosions.…”

Section: Discussionmentioning

confidence: 98%

Spinal Gout

Draganescu¹,

Leventhal²

2004

JCR: Journal of Clinical Rheumatology

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Spinal involvement is considered to be a rare complication of gout. We report a case of a 48-year-old woman with chronic tophaceous gout, recently desensitized to allopurinol, who presented with an L4 radiculopathy. A magnetic resonance image (MRI) of the lumbosacral spine revealed an extradural process at L4 level. Three months before this episode, for unrelated reasons, the patient had an MRI of her entire spine, which was normal. Laminectomy was performed revealing a large gouty tophus. The fact that a large gouty tophus formed over this short a period of time causing neurologic symptoms highlights the importance of aggressive medical management of patients with longstanding tophaceous gout with urate-lowering agents. Spinal extradural gout could lead to neurologic deficits necessitating emergent surgery for decompression, exposing the patient to further risk. Every effort should be made to lower the serum uric acid level by maximizing the pharmacologic regimen and, if necessary, desensitizing the patient, like in our case, if there is a history of allergy to allopurinol.

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Section: Discussionmentioning

confidence: 98%

Spinal Gout

Draganescu¹,

Leventhal²

2004

JCR: Journal of Clinical Rheumatology

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“…Barrett et al (1) stated prior to 2001 that only 37 cases of gouty arthritis of the spine had been previously reported. According to the literature, spinal tophaceous gout can vary in presentation, ranging from cervical neck pain to acute paraparesis in patients with a previous history of gout (1,2,7,12). Tophi are the chronic manifestations of the clinical disease progression of gouty arthritis.…”

Section: Discussionmentioning

confidence: 99%

Tophaceous gout of the lumbar spine: case report and review of the literature

Волков

Rhoiney²,

Claybrooks³

2014

Turkish Neurosurgery

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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 ÖZTofüslü gut, klasik olarak ekstremitelerin hastalığı olarak tanımlanmakla birlikte 1947 yılında omurganın da tutulumu rapor edilmiştir. Bu olgu sunumunda C3-C4 seviyesinde servikal miyelopati nedeniyle anterior servikal diskektomi ve füzyon planlanan ancak acil servise alt ekstremitelerde progresif güç kaybı ve 3 gündür yürüyememe şikayeti ile başvuran 63 yaşında erkek hastayı sunuyoruz. Fizik muayene hastanın servikal miyelopatisinde muhtemel bir ilerlemeyi işaret ediyordu ancak manyetik rezonans görüntüleme (MRG) bulgularında bir değişiklik olmadığı görüldü. Ameliyat günü hastanın ateşi çıktı ve bel ağrısı ön plana çıktı. Bunun üzerine hastada enfeksiyon kaynağı araştırılmaya başlandı ve lomber spinal MRG yapıldı. Görüntülemenin sonucunda lomber spinal epidural apse ve dural kesede bası tesbit edildi. Acil L4-L5 dekompresyon yapıldı ve tebeşir renkli materyal boşaltılarak patolojik inceleme için gönderildi. Patolojik inceleme sonucunda hastada lomber omurgada tofüslü gut tanısı konuldu. Makalemizde bu olgunun yönetimini sunmayı amaçladık ve ilgili literatürü tanı ve tedavideki yaklaşımı kolaylaştırmak için taradık.

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“…[1][2][3][4] Recently, it has been noted that this response may require prolonged therapy,2 but can be maintained with alternate-day corticosteroid administration.3 Some authors have not noted a beneficial effect5 or have noted a worsening with corticosteroid therapy.4.6 The possibility that an initial worsening might precede improvement has not been considered. [1][2][3][4] Recently, it has been noted that this response may require prolonged therapy,2 but can be maintained with alternate-day corticosteroid administration.3 Some authors have not noted a beneficial effect5 or have noted a worsening with corticosteroid therapy.4.6 The possibility that an initial worsening might precede improvement has not been considered.…”

Section: Diphasic Response Tomentioning

confidence: 99%