Diagnostic challenges of spinal gout :A case series

Abstract

Introduction: Spinal gout is rarely encountered in clinical practice, is easily misdiagnosed, and often remains undiagnosed. This paper aims to provide some clues that are the salient diagnostic features of spinal gout, particularly axial pain, radiculopathy, and myelopathy, as determined on the basis of our experience with a few cases as well as a literature review. Methods: We retrospectively reviewed the clinical data of 5 patients that were treated for axial pain and neurological symptoms associated with spinal gout between 2014 and 2017 in our hospital. Herein, we systematically describe the clinical characteristics of 5 patients with spinal gout. The 5 patients included 4 men and 1 woman, aged between 24 and 75 years. The most common clinical presentation included spinal pain, radiculopathy, and myelopathy. Four of the 5 patients had a history of gout and elevated serum uric acid levels. Results: Four patients underwent surgery, while the remaining patient underwent conservative treatment and biopsy due to poor general condition. Pathological examination of the surgical samples in the 4 surgical cases and the biopsy sample in the remaining case confirmed the presence of spinal gout tophi. The neurological symptoms of all 5 patients were relieved after treatment. Conclusion: Due to its rarity and lack of typical defining criteria, the diagnosis of spinal gout is quite difficult. We recommend that patients presenting with axial pain; radicular pain or myelopathy; and especially high uric acid levels, with or without a history of gout, should be evaluated for spinal gout. Timely pathological examination of surgical or biopsy samples would help confirm the diagnosis and enable practitioners to provide the appropriate treatment to prevent disease progression. Abbreviations: ACDF = anterior cervical discectomy and fusion, BBD = bowel/bladder dysfunction, CKD = chronic kidney diseases, CLF = cervical ligamentum flavum, CT = computed tomography, ESR = erythrocyte sedimentation rate, Hx = history, Hyper = hyperintense, Hypo = hypointense, Iso = isontense, Lam = laminectomy, LE = lower extremity, MEY = myelopathy, MISTLIF = minimally invasive transforaminal lumbar interbody fusion, MRI = magnetic resonance imaging, MSU = monosodium urate crystals, PLCL = poster longitudinal cervical ligament, RAD = radiculopathy, Sx = symptoms, T1W = T1-weighted, T2W = T2-weighted, UE = upper extremity, WBC = white blood cell.