Wang Wei, Li Qingbo, Cai Lei, Liu Weijun
Department of Orthopaedics, Pu Ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Ther Clin Risk Manag. 2017 Sep 28;13:1287-1293. doi: 10.2147/TCRM.S145906. eCollection 2017.
Tophaceous gout seldom affects the axial skeleton. Symptoms vary according to the differential localization of urate deposits and the diagnosis is often delayed. Here, we report an unusual case of lumbar spinal stenosis caused by extradural tophaceous deposits.
We retrospectively reviewed a case of a patient with tophaceous gout of the lumbar spine and reviewed the relevant literature.
A 62-year-old man with a 2-year history of lower back pain and a 3-month history of lower limb radiation pain and intermittent claudication was admitted. After laboratory and imaging investigations he underwent surgical decompression and stabilization. Histological analysis of the extracted specimen confirmed that it was gouty tophus. The patient's symptoms improved progressively after the operation. He recovered very well with no complications.
The mechanism associated with axial gout is not yet clear. Obesity, inactivity, and previous degenerative disc disease may be the risk factors for spinal tophus. The clinical symptoms are diverse according to the differential localization of urate deposits. It is not easy to diagnose this disease radiographically by routine radiological examination. Analysis of a biopsy specimen is definitely the only way to confirm diagnosis. Surgical treatment should be considered in patients with spinal gout who are experiencing neurological deterioration.
痛风石性痛风很少累及中轴骨骼。症状因尿酸盐沉积的不同部位而异，诊断往往延迟。在此，我们报告一例由硬膜外痛风石沉积引起的腰椎管狭窄罕见病例。
我们回顾性分析了一例腰椎痛风石患者的病例，并复习了相关文献。
一名62岁男性因下背痛2年、下肢放射性疼痛和间歇性跛行3个月入院。经过实验室和影像学检查后，他接受了手术减压和固定。对取出标本的组织学分析证实为痛风石。术后患者症状逐渐改善。他恢复得很好，没有并发症。
与中轴痛风相关的机制尚不清楚。肥胖、缺乏运动和既往椎间盘退变疾病可能是脊柱痛风石的危险因素。临床症状因尿酸盐沉积的不同部位而多样。通过常规放射学检查在影像学上诊断此病并不容易。活检标本分析绝对是确诊的唯一方法。对于出现神经功能恶化的脊柱痛风患者应考虑手术治疗。
