Multilevel Lumbar Stenosis Caused by Large Tophi Involving Both Spinal Canal and Posterior Spinal Elements: A Rare Case Report and Literature Review

Yang Liu, Xueshi Li, Genlong Jiao, Pan Zhou, Zhizhong Li

Abstract


Tophus is a characteristic manifestation of gout entering the chronic phase, which usually deposits in the joints of the extremities, skin mucosa, etc. A gout tophus that involves the spine causing spinal stenosis is rare and it can be misdiagnosed as a spinal tumor preoperatively. We report the case of a 35-year-old man who presented with lumbar stenosis symptoms, and suffered multiple-site gout tophi involvement throughout his body. Radiographic examinations showed that the large tophi infiltrated the posterior elements of the spine and encroached the lumbar spinal canal, resulting in neurologic compression from the second to the fifth lumbar level. Urate could be observed on a dual-energy computed tomography. A posterior-based procedure was performed to eradicate the tophi and stabilize the spine. Finally, urate crystal was confirmed by postoperative pathological examination. Here, the clinical manifestations, radiological, pathological and surgical features for this case are reported.




J Med Cases. 2019;10(11):333-337
doi: https://doi.org/10.14740/jmc3392

Keywords


Gout; Tophus; Tophi; Lumbar spine; Spinal stenosis

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