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  • Title: Intraspinal extradural gout tophus in the lumbar vertebral canal: Case reports.
    Author: Wu Z, Liu C, Dai K, Zheng C.
    Journal: Medicine (Baltimore); 2022 Jan 07; 101(1):e28418. PubMed ID: 35029886.
    Abstract:
    RATIONALE: Intraspinal gout tophus in the lumbar vertebral canal associated with gouty arthritis is rare. We present 2 cases with the first manifestations of a sequestrated intervertebral disc and an extradural tumor, and histopathologically proven to be gouty deposits in the lumbar vertebral canal. PATIENT CONCERNS: The 2 patients presented with typical radiculopathy symptoms and a positive straight leg raise. In 1 case, there was weakness of the left toe extensors, with a positive left femoral nerve traction test. Additionally, the left patellar tendon reflex was weak. In the other patient who was unable to walk, there was a sensory deficit in the saddle distribution. DIAGNOSIS: Histopathological examination of the specimens taken from the operation confirmed the presence of gouty deposits. INTERVENTIONS: Posterior decompression was performed in these 2 cases, and chalky-white materials were identified in the lumbar vertebral canal. OUTCOMES: No evidence of neoplasm, infection, or synovial cyst was found. LESSONS: Definitive diagnosis of intraspinal extradural gout tophus, mimicking a sequestrated intervertebral disc or an extradural tumor, may be difficult. The initial suspicion of intraspinal gouty deposits, based on the diagnostic/management algorithm, may effectively avoid incorrect diagnosis via a less invasive procedure than explorative laminectomy.
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