Percutaneous endoscopic treatment for cervical ligamentum flavum gouty tophus: A case report

Abstract

Rationale: Cervical ligamentum flavum gout (CLFG) is relatively rare, and its clinical manifestations are complicated; hence, it is often confused with ligamentum flavum ossification. Gout tophi may relate to certain risk factors, such as renal insufficiency and lack of long-term effective uric acid treatment. Patient concerns: A 73-year-old man had a half-year history of left upper extremity pain and numbness, which was aggravated 6 months ago. Diagnoses: Computed tomography (CT) indicated spinal stenosis at the level of C5/6. Cervical stenosis was believed to be mostly related to the ossification of ligamentum flavum. The histological examination of the material removed during the surgery revealed fibrous tissues with pools of amorphous debris having a foreign body giant cell reaction, which is typical of urate gout. Interventions: We performed complete decompressions for this case with CLFG using posterior percutaneous endoscopic technique. Outcomes: The patient experienced a progressive improvement in the left upper extremity pain after the surgery, and no signs of cerebrospinal fluid leakage, infection, or other complications were experienced. Lessons: The clinician should include spinal gout in the differential diagnosis when dealing with patients with hyperuricemia, renal insufficiency, and axial pain with or without neurologic deficits. We have applied the percutaneous endoscopic technique for the treatment of spinal gout. It performed direct decompression with minimizing trauma and instability, which could be used as an alternative choice.