Liu T, Liu H, Zhu T
Department of Neurosurgery, Tianjin Medical University, General Hospital , Tianjin, China .
Spinal Cord Ser Cases. 2015 Oct 8;1:15015. doi: 10.1038/scsandc.2015.15. eCollection 2015.
Case report and literature review.
Gouty arthritis of the spine is rare. Gout presenting as back pain and quadriplegia may be difficult to distinguish from a spinal tumor. Symptoms vary, and the diagnosis is often delayed. We report an unusual case of thoracic spinal cord compression caused by extradural tophaceous deposits whose initial diagnosis had been lymphoid malignancy. To the best of our knowledge, this is only the second report of using single-photon emission computed tomography (SPECT) to diagnose spinal tophus.
We retrospectively reviewed the medical records, operative reports and radiographic imaging studies of a single patient.
A 26-year-old man with severe tophaceous gout presented with a 4-month history of progressive weakness and dyschesia of both lower extremities. Coronal bone slices evaluated by SPECT indicated increased methylene diphosphonate uptake in the T9 and T10 pedicles. Pathology assessment revealed areas of amorphous substance containing urate crystals surrounded by inflammatory cells. The diagnosis was gouty tophus.
The position of the spinal tophus may be related to the 'S' type of spinal anatomical structure. Obesity and inactivity may be the two risk factors for spinal tophus. Every effort should be made to lower the serum uric acid level by maximizing the pharmacological regimen. We believe that laminectomy can effectively relieve spinal cord compression. It also improves the long-term prognosis for spinal gouty tophus. SPECT may be a viable method for differentiating spinal gout and a malignant tumor.
病例报告及文献综述。
脊柱痛风性关节炎较为罕见。痛风表现为背痛和四肢瘫痪时，可能难以与脊柱肿瘤相区分。症状各异，诊断往往延迟。我们报告一例不寻常的病例，硬膜外痛风石沉积导致胸段脊髓受压，其最初诊断为淋巴恶性肿瘤。据我们所知，这是第二例使用单光子发射计算机断层扫描（SPECT）诊断脊柱痛风石的报告。
我们回顾性分析了一名患者的病历、手术报告及影像学检查。
一名26岁重度痛风石性痛风男性患者，有4个月双下肢进行性无力和排便困难病史。SPECT评估的冠状位骨切片显示T9和T10椎弓根二膦酸盐摄取增加。病理评估显示有无定形物质区域，内含尿酸盐结晶，周围有炎症细胞。诊断为痛风石。
脊柱痛风石的位置可能与脊柱“S”型解剖结构有关。肥胖和缺乏运动可能是脊柱痛风石的两个危险因素。应尽最大努力通过优化药物治疗方案降低血清尿酸水平。我们认为椎板切除术可有效缓解脊髓压迫。这也改善了脊柱痛风石的长期预后。SPECT可能是鉴别脊柱痛风和恶性肿瘤的可行方法。
