Cervical myelopathy due to gouty tophi in the intervertebral disc space.
Gout, like diabetes mellitus, is a common metabolic disorder. Typically affecting the distal joint of the appendicular skeleton, its occurrence in the spine is rare. We report the case of a 68-year-old male with a long history of diabetes mellitus and hyperuricemic gout. Neck pain developed over two weeks with subsequent quadriparesis, with concomitant subcutaneous deposition of gouty tophi in the right elbow. Magnetic resonance image of the cervical spine revealed multiple segmental narrowing of the thecal sac at the C3-6 levels due to hypertrophic spurs and bulging discs. Anterior discectomies of C3-4 and C4-5 were performed, with a chalky-white, granular material noted in the C4-5 disc space. Histological examination of the surgical specimen revealed deposits of needle-like crystals surrounded by histiocytes and multinucleated giant cells, with the appearance compatible with gout. The patient was ambulatory with the assistance of a walking frame six months after the operation. We emphasize that gouty tophi can be deposited in the spine over a relatively short time, subsequently precipitating a variety of symptoms, from pain to cord compression. The regular administration of antihyperuricemia drug treatment for hyperuricemic gout is necessary to prevent this deposition. If neurological defects are found, surgical decompression can provide satisfactory results.
Yen
H-L
HL
Department of Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung, 123 Ta-Pei Road, Niao-Sung Hsiang, Kao-hsiung Hsien, Taiwan.
Cheng
C-H
CH
Lin
J-W
JW
D000368:Aged; D002574:Cervical Vertebrae / Q000473:pathology*; D048909:Diabetes Complications; D006073:Gout / Q000150:complications*; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D010146:Pain / Q000209:etiology; D013117:Spinal Cord Compression; D013118:Spinal Cord Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery