Diaz A, Porhiel V, Sabatier P, Taha S, Ragragui O, Comoy J, Leriche B
Service de Neurochirurgie, CH Sud-Réunion, 97448 Saint-Pierre Cedex.
Neurochirurgie. 2003 Dec;49(6):600-4.
We present the case of a 74-year-old patient with long-standing gout who developed C4-C5 tophaceous gout causing cord compression. The patient had undergone 4 years earlier for a disco-osteophytic cord compression (anterior C4-C5 and C5-C6 discectomy). When admitted, the patient presented quadriparesia which had developed during the previous week in association with acute tophaceous gout on the knees, and the metarsophalangeal articulations, in the context of a bronchial infection. The diagnosis of spondylodiscitis was initially retained because of the clinical features of severe infection and the radiological data (C4-C5 cord compression, with anterior epidural lesions in MRI). The intervention allowed decompression and pathological diagnosis of tophaceous gout. Spinal gout is well-known, and very rarely responsible for cord compression: only 15 cases of cervical gout have been described in the literature. Radiological findings are not specific, and treatment is surgical in the event of medullar compression despite medical treatment.
我们报告一例74岁长期痛风患者，其C4 - C5出现痛风石性痛风，导致脊髓受压。该患者4年前曾因椎间盘骨赘性脊髓受压（C4 - C5和C5 - C6前路椎间盘切除术）接受治疗。入院时，患者出现四肢瘫，这是在之前一周内与支气管感染相关的急性痛风石性痛风同时出现在膝关节和跖趾关节时发展而来的。由于严重感染的临床特征和放射学数据（C4 - C5脊髓受压，MRI显示硬膜外前部病变），最初诊断为脊椎椎间盘炎。手术干预实现了减压并对痛风石性痛风进行了病理诊断。脊柱痛风是众所周知的，很少导致脊髓受压：文献中仅描述了15例颈椎痛风病例。放射学表现不具有特异性，尽管进行了药物治疗，但在出现髓质受压的情况下，治疗方法为手术治疗。
