Gout in the Spine: Imaging, Diagnosis, and Outcomes

Abstract

Gout is characterized by the deposition of monosodium urate crystals and by acute and chronic inflammation in response to crystals so deposited. Multiple case reports and series describe the deposition of monosodium urate in the spine as a rare manifestation of gout, but the actual prevalence of spinal involvement is unknown and likely to be higher than generally anticipated. Here we review the characteristics of 131 previously reported cases of spinal involvement in gout. We focus in particular on the use of imaging modalities and the extent to which they correlate with presenting symptoms and tissue diagnoses. The recent innovation of using dual-energy computerized tomography to identify urate crystal deposition holds promise for reducing the need for surgical intervention and for establishing a true prevalence rate for spinal gout.

Spinal gout causing reversible quadriparesis: a case report and literature review

“…Eleven of the 131 cases were diagnosed clinically without biopsy confirmation, similar to our patient [9]. Of the total 131 reported cases, 37% were treated with only medical management, with 45% of those cases having complete symptom resolution, similar to our patient [9]. …”

“…In the comprehensive review of all spinal gout cases done by Toprover et al in 2015, 131 cases were reviewed including a comparison of diagnosis and treatment courses [9]. Eleven of the 131 cases were diagnosed clinically without biopsy confirmation, similar to our patient [9]. Of the total 131 reported cases, 37% were treated with only medical management, with 45% of those cases having complete symptom resolution, similar to our patient [9].…”

“…This includes vertebral bodies, pedicules, laminae, interapophyseal cartilage, epidural spaces and intradural spaces [10]. In the comprehensive review of all spinal gout cases done by Toprover et al in 2015, 131 cases were reviewed including a comparison of diagnosis and treatment courses [9]. Eleven of the 131 cases were diagnosed clinically without biopsy confirmation, similar to our patient [9].…”

“…By 1976, three more cases of spinal gout were reported that required neurosurgical intervention of the ligamentum flavum due to urate deposition causing neurological compromise [8]. By 2015, the number of reported cases of spinal gout has increased to 131, with more than 50 percent involving the lumbar spine [9]. The reported cases revealed that many spinal regions can be affected by gout [10].…”

Minimally Invasive Excision of Lumbar Tophaceous Gout: Case Report

“…5,6 Gout could involve all the segments of the spine but it appears to be more common in the lumbar spine (44-54%). 7,8 Deposits of tophaceous gout could be found in any part of the vertebra, including facet joint, 9 vertebral body, 10 pedicle, 11 lamina, 12 ligamentum flavum, 13 and disc. 14,15 Symptomatic spinal gout can present with features of back pain, spinal stenosis, myelopathy, radiculopathy and cauda equina syndrome.…”