Percutaneous transforaminal endoscopic decompression for the treatment of intraspinal tophaceous gout

Abstract

Rationale: Intraspinal tophaceous gout is relatively rare condition presenting with major clinical manifestations, such as spinal cord or nerve roots compressions (radiculopathy). It is usually difficult to differentiate intraspinal tophaceous gout, lumbar disc herniation, stenosis of spinal canal, ossification of ligamentum flavum, and other degenerative spinal disorders from each other. Patient concerns: A 64-year-old man was admitted with a history of progressive low back pain for 11 months. He also presented with radiculopathy and numbness of his left lower extremity. Diagnoses: Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) showed L4/5 disc herniation and lateral recess stenosis on the left side. During the operation of percutaneous transforaminal endoscopic decompression, intraspinal chalky white material was seen. Post-operative pathologic results confirmed the diagnosis of gouty tophi. Interventions: Percutaneous transforaminal endoscopic decompression was performed as treatment. Intraspinal chalky white material was seen. We removed most of the chalky white material and extruded nucleus. Outcomes: His symptom subsided rapidly and no deterioration was noted 1 year post-operatively. Lessons: Although intraspinal tophaceous gout is not commonly seen, clinicians should take it into consideration as a possible differential diagnosis when the patient exhibits axial pain or neurological deficits with risk factors of gout. We identified and treated this case with percutaneous transforaminal endoscopic decompression for the first time and got an excellent outcome. Percutaneous transforaminal endoscopic surgery proved to be an effective and minimally invasive alternative for identifying and treating intraspinal tophaceous gout.

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

“…It was estimated that 65.4% of patients had some kind of neurological deficit, such as loss of sensation, radiculopathy, bowel/bladder dysfunction, motor weakness or even quadriparesis ( 2 ). Owing to its diverse location in the spine and atypical clinical symptoms, the differential diagnosis includes epidural abscess, metastatic disease, spondylodiscitis, rheumatoid arthritis and other degenerative spinal disorders ( 3 , 7 ). It was also reported that ~24.6% of patients with spinal gout had no history of gout or hyperuricemia ( 2 ).…”

“…It was also reported that ~24.6% of patients with spinal gout had no history of gout or hyperuricemia ( 2 ). Although relatively rare, orthopedic surgeons should take it into consideration as a differential diagnosis when the patient has chronic lower back pain, even if the patient has normal serum uric acid levels and no history of gout ( 3 ).…”

“…Owing to the high uric acid dietary changes over the past few decades, the prevalence of tophaceous gout has increased significantly ( 2 ). Spinal gout is also reported and due to the asymptomatic development and insidious onset in the majority of patients, the incidence of spinal gout may be highly underestimated ( 3 ).…”

“…Differential diagnoses of spinal gout include ossification of the ligamentum flavum, stenosis of the spinal canal, lumbar disc herniation and other degenerative spinal disorders. Due to the rareness and atypical symptoms in most of the cases, the definite diagnosis of spinal gout is usually challenging to orthopedic surgeons ( 3 ). In the present study, the clinical, imaging and pathologic findings of a patient with radiculopathy caused by this unusual presentation of spinal gout are reported.…”

Percutaneous Transforaminal Endoscopic Foraminoplasty and Decompression for the Treatment of Intraspinal Tophaceous Gout: A Case Series

“…Symptomatic intraspinal gout is rare, and there is no consensus on its treatment to date. The majority of relevant studies have demonstrated that open laminectomy is the rst choice for selected patients, but it is often accompanied by a large incision and a spinal instability postoperation [2][3][4][5] . Recently, we rst applied percutaneous transforaminal endoscopy for intraspinal gout, and the symptoms of neurological de cits and pain were immediately relieved without complications postoperatively.…”