Barrett K, Miller M L, Wilson J T
Division of Nephrology, Maine Medical Center, Portland 04102, USA.
Neurosurgery. 2001 May;48(5):1170-2; discussion 1172-3. doi: 10.1097/00006123-200105000-00046.
Tophaceous gout uncommonly affects the axial skeleton. The clinical presentations of gout of the spine range from back pain to quadriplegia. Gout that presents as back pain and fever may be difficult to distinguish from spinal infection. We present a case of a patient with tophaceous gout of the lumbar spine who was initially diagnosed with and treated for an epidural infection. The clinical and diagnostic features of tophaceous gout of the spine are reviewed.
A 70-year-old man presented with a 2-day history of fever and back pain. A physical examination revealed that he had flank tenderness and evidence of polyarthritis affecting the elbows, knees, and right first metatarsophalangeal joint. A magnetic resonance imaging scan of the patient's lumbar spine showed an extensive area of abnormal gadolinium enhancement of the paramedian posterior soft tissues from L3 to S1 with an area of focal enhancement extending into the right L4-L5 facet joint.
A laminectomy was performed at L4-L5, and a chalky white material in the facet joint was found eroding into the adjacent pars intra-articularis. Light and polarizing microscopy confirmed the presence of gouty tophus. No evidence of infection was found.
Gouty arthritis of the spine is rare. Thirty-seven previous cases have been reported. When the clinical presentation includes acute back pain and fever, differentiation of spinal gout from spinal infection may be difficult. The clinical suspicion of spinal gout may lead to the correct diagnosis by a less invasive approach than exploration and laminectomy.
痛风石性痛风很少累及中轴骨骼。脊柱痛风的临床表现从背痛到四肢瘫痪不等。表现为背痛和发热的痛风可能难以与脊柱感染相鉴别。我们报告一例腰椎痛风石性痛风患者，最初被诊断为硬膜外感染并接受治疗。本文对脊柱痛风石性痛风的临床及诊断特征进行了综述。
一名70岁男性，有2天发热和背痛病史。体格检查发现他有侧腹压痛，并有累及肘部、膝部和右第一跖趾关节的多关节炎证据。患者腰椎的磁共振成像扫描显示，从L3至S1的旁正中后软组织有广泛的钆异常强化区域，一个局灶性强化区域延伸至右侧L4-L5小关节。
在L4-L5行椎板切除术，发现小关节内有灰白色物质侵蚀相邻的关节内部分。光镜和偏振显微镜检查证实存在痛风石。未发现感染证据。
脊柱痛风性关节炎罕见。此前已报道37例。当临床表现包括急性背痛和发热时，脊柱痛风与脊柱感染的鉴别可能困难。对脊柱痛风的临床怀疑可能通过比探查和椎板切除术侵入性更小的方法得出正确诊断。
