Chen Xinji, Xu Guokang, Hu Qingfeng, Zhao Tingxiao, Bi Qing, Huang Yazeng, Shao Haiyu, Zhang Jun
Department of Orthopedics, Zhejiang Provincial People's Hospital.
Hangzhou Medical College People's Hospital, Hangzhou.
Medicine (Baltimore). 2020 May 22;99(21):e20125. doi: 10.1097/MD.0000000000020125.
Intraspinal tophaceous gout is relatively rare condition presenting with major clinical manifestations, such as spinal cord or nerve roots compressions (radiculopathy). It is usually difficult to differentiate intraspinal tophaceous gout, lumbar disc herniation, stenosis of spinal canal, ossification of ligamentum flavum, and other degenerative spinal disorders from each other.
A 64-year-old man was admitted with a history of progressive low back pain for 11 months. He also presented with radiculopathy and numbness of his left lower extremity.
Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) showed L4/5 disc herniation and lateral recess stenosis on the left side. During the operation of percutaneous transforaminal endoscopic decompression, intraspinal chalky white material was seen. Post-operative pathologic results confirmed the diagnosis of gouty tophi.
Percutaneous transforaminal endoscopic decompression was performed as treatment. Intraspinal chalky white material was seen. We removed most of the chalky white material and extruded nucleus.
His symptom subsided rapidly and no deterioration was noted 1 year post-operatively.
Although intraspinal tophaceous gout is not commonly seen, clinicians should take it into consideration as a possible differential diagnosis when the patient exhibits axial pain or neurological deficits with risk factors of gout. We identified and treated this case with percutaneous transforaminal endoscopic decompression for the first time and got an excellent outcome. Percutaneous transforaminal endoscopic surgery proved to be an effective and minimally invasive alternative for identifying and treating intraspinal tophaceous gout.
脊柱内痛风石相对罕见，可出现诸如脊髓或神经根受压（神经根病）等主要临床表现。通常很难将脊柱内痛风石与腰椎间盘突出症、椎管狭窄、黄韧带骨化及其他脊柱退行性疾病相互鉴别。
一名64岁男性因进行性下腰痛11个月入院。他还伴有神经根病及左下肢麻木。
术前计算机断层扫描（CT）和磁共振成像（MRI）显示L4/5椎间盘突出及左侧侧隐窝狭窄。在经皮椎间孔镜减压手术过程中，发现脊柱内有灰白色物质。术后病理结果证实为痛风石。
采用经皮椎间孔镜减压术进行治疗。术中可见脊柱内灰白色物质。我们清除了大部分灰白色物质及突出的髓核。
他的症状迅速缓解，术后1年未见病情恶化。
尽管脊柱内痛风石并不常见，但当患者出现轴向疼痛或神经功能缺损且有痛风危险因素时，临床医生应将其作为可能的鉴别诊断加以考虑。我们首次采用经皮椎间孔镜减压术对该病例进行识别和治疗，取得了良好效果。经皮椎间孔镜手术被证明是识别和治疗脊柱内痛风石的一种有效且微创的替代方法。
