Ma Shaolong, Zhao Jianhui, Jiang Rui, An Quanming, Gu Rui
Department of orthopedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China.
Medicine (Baltimore). 2019 Apr;98(16):e15265. doi: 10.1097/MD.0000000000015265.
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.
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.
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.
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.
脊柱痛风在临床实践中很少见，容易误诊，且常常未被诊断出来。本文旨在根据我们对少数病例的经验以及文献综述，提供一些作为脊柱痛风显著诊断特征的线索，特别是轴向疼痛、神经根病和脊髓病。
我们回顾性分析了2014年至2017年在我院接受治疗的5例与脊柱痛风相关的轴向疼痛和神经症状患者的临床资料。在此，我们系统地描述了5例脊柱痛风患者的临床特征。这5例患者包括4名男性和1名女性，年龄在24岁至75岁之间。最常见的临床表现包括脊柱疼痛、神经根病和脊髓病。5例患者中有4例有痛风病史且血清尿酸水平升高。
4例患者接受了手术，其余1例患者由于全身状况较差接受了保守治疗和活检。4例手术病例的手术样本及其余1例病例的活检样本的病理检查证实存在脊柱痛风石。所有5例患者经治疗后神经症状均得到缓解。
由于脊柱痛风罕见且缺乏典型的诊断标准，其诊断相当困难。我们建议，对于出现轴向疼痛、神经根性疼痛或脊髓病，尤其是尿酸水平升高，无论有无痛风病史的患者，都应评估是否患有脊柱痛风。及时对手术或活检样本进行病理检查将有助于确诊，并使医生能够提供适当的治疗以防止疾病进展。
