title: Thoracic cord compression due to ligamentum flavum gouty tophus: a case report and literature review.
abstract: METHODS
  Here we describe a patient who developed myelopathy due to gouty tophi of the ligamentum flavum in the thoracic spine. We also review similar cases previously reported in the literature.
  
  
  OBJECTIVE
  Our aim was to present a case of myelopathy due to thoracic spinal gouty tophus.
  
  
  METHODS
  We report the case of a 56-year-old male with history of peripheral gout and renal insufficiency. The patient complained of back pain and paraparesis of the left lower limb. Multiple tophi were noted over several interphalangeal and metatarsophalangeal joints. Neurological examination showed decreased left lower limb strength and a positive Babinski sign. Magnetic resonance imaging of the thoracic spine revealed hypertrophy of the ligamentum flavum at the level of T3/T4, T5/T6, T9/T10, T10/T11 and T11/T12.
  
  
  RESULTS
  A thoracic laminectomy at T1-T5 was performed. Chalky white granular material was found in the ligamentum flavum during surgery. Histological analysis of the specimen demonstrated a gouty tophus. The patient's back pain and paraparesis of the lower left limb improved.
  
  
  CONCLUSIONS
  The clinician should include spinal gout in the differential diagnosis when dealing with patients with gout and axial pain with or without neurologic deficits. If this diagnosis is seriously entertained, then a CT scan or magnetic resonance imaging as well as tissue biopsy may be needed to establish the diagnosis.
authors.affiliation: Department of Nephrology, General Hospital of Tianjin Medical University, Tianjin, China.
authors.forename: Z-F
authors.initials: ZF
authors.lastname: Zheng
authors.affiliation: Department of Radiology, General Hospital of Tianjin Medical University, Tianjin, China.
authors.forename: H-L
authors.initials: HL
authors.lastname: Shi
authors.affiliation: Department of Nephrology, General Hospital of Tianjin Medical University, Tianjin, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Xing
authors.affiliation: Department of Nephrology, General Hospital of Tianjin Medical University, Tianjin, China.
authors.forename: D
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Nephrology, General Hospital of Tianjin Medical University, Tianjin, China.
authors.forename: J-Y
authors.initials: JY
authors.lastname: Jia
authors.affiliation: Department of Nephrology, General Hospital of Tianjin Medical University, Tianjin, China.
authors.forename: S
authors.initials: S
authors.lastname: Lin
mesh_terms: D001416:Back Pain / Q000209:etiology; D006073:Gout / Q000209:etiology; D006801:Humans; D007796:Laminectomy / Q000379:methods; D017843:Ligamentum Flavum / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D013117:Spinal Cord Compression / Q000209:etiology* / Q000601:surgery; D013118:Spinal Cord Diseases / Q000209:etiology*; D013119:Spinal Cord Injuries / Q000150:complications*; D013904:Thoracic Vertebrae / Q000473:pathology