Gouty arthropathy of the lumbar spine: a case report and review of the literature.
METHODS
A patient with hyperuricemia developed symptoms from lateral recess stenosis attributed to gouty arthropathy of a lumbar facet joint.


OBJECTIVE
To present the diagnosis and management of gouty arthropathy of the lumbar spine in one individual.


BACKGROUND
The symptoms and treatment of a patient with intra-articular gout of a lumbar facet are presented and contrasted with other cases of spinal extra-articular gout found in the literature.


METHODS
A patient with hyperuricemia reported back pain and symptoms consistent with lateral recess stenosis. Conservative treatment failed, and, after further evaluation, a successful decompressive laminectomy was performed. Pathology revealed intra-articular urate crystal deposition.


RESULTS
This patient's unilateral S1 radiculopathy corresponded with magnetic resonance and computed tomography studies documenting unilateral lateral L5-S1 lateral recess stenosis secondary to intra-articular gouty arthropathy. As anticipated, the serum uric acid also was elevated. Since surgical decompression with unilateral laminotomy was performed, the patient has been symptom-free for 2 years.


CONCLUSIONS
Although rare, gouty arthropathy of the lumbar facet joint should be considered in all patients with neurologic symptoms and known or suspected gout. Optimization of pharmacologic treatment is indicated for patients suspected of having gouty neuropathy. Surgical decompression is indicated if conservative management with Indocin, nonsteroidal anti-inflammatory agents, and allopurinol fails to reverse neurologic dysfunction.
King
J C
JC
Kalamazoo Center for Medical Studies, Michigan State University, 49008, USA.
Nicholas
C
C
D000328:Adult; D015210:Arthritis, Gouty / Q000097:blood / Q000473:pathology* / Q000628:therapy; D003937:Diagnosis, Differential; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D013126:Spinal Nerve Roots / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014527:Uric Acid / Q000097:blood
D014527:Uric Acid