Koro Lacin, Khanna Ryan, Richards Dominick, Karahalios Dean G
Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois; and.
Brain & Spine Institute, Advocate Aurora Health, Downers Grove, Illinois.
J Neurosurg Case Lessons. 2021 Aug 30;2(9):CASE21308. doi: 10.3171/CASE21308.
Although spinal involvement by gout is not uncommon, spinal gout leading to symptomatic spinal cord compression in the thoracic spine is very rare and poses a diagnostic challenge by mimicking symptoms of more common diagnoses such as epidural abscess and malignancy. An even more unique presentation is spinal gout causing thoracic cord compression leading to acute paraplegia.
The authors present an illustrative case of a 35-year-old man with thoracic spinal compression by tophaceous gout who developed rapid progression to complete paraplegia over a 5-day period. Magnetic resonance imaging of the thoracic spine revealed a cystic-appearing lesion within the dorsal extradural space of the lower thoracic spine extending from T8 to T10 accompanied by compression of the spinal cord. An emergent T9-10 laminectomy was performed, and the occupying lesion in the thoracic spine was resected. The diagnosis of spinal tophaceous gout was made by pathological examination.
Although varying clinical manifestations of spinal gout have been reported in the literature, the patient's age and the rapid progression to complete paraplegia over a 5-day period reveals a unique presentation that broadens understanding of the manner in which this condition can present and allow more rapid diagnosis and treatment.
尽管痛风累及脊柱并不少见，但导致胸椎出现症状性脊髓压迫的脊柱痛风非常罕见，且因其症状与硬膜外脓肿和恶性肿瘤等更常见疾病相似，给诊断带来挑战。一种更为独特的表现是脊柱痛风导致胸段脊髓受压，进而引发急性截瘫。
作者报告了一例具有代表性的病例，一名35岁男性因痛风石性痛风导致胸椎受压，并在5天内迅速发展为完全性截瘫。胸椎磁共振成像显示，下胸椎（T8至T10）背侧硬膜外间隙有一个囊肿样病变，并伴有脊髓受压。急诊行T9 - 10椎板切除术，切除胸椎占位性病变。通过病理检查确诊为脊柱痛风石性痛风。
尽管文献中已报道了脊柱痛风的多种临床表现，但该患者的年龄以及在5天内迅速发展为完全性截瘫，呈现出一种独特的表现形式，拓宽了我们对这种疾病表现方式的理解，有助于实现更快速的诊断和治疗。
