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Foraminal stenosis and radiculopathy secondary to tophaceous gout: illustrative case – Lumbar Spinal Stenosis

This article discusses a case of tophaceous gout, which is a severe form of gout that results in the formation of large nodules in the joints and surrounding tissues. The case involves a 47-year-old female with a history of chronic renal disease, obesity, gout, inflammatory polyarthritis, and multiple sclerosis. She presented with low-back pain and lumbar radiculopathy, and imaging revealed foraminal stenosis and spondylolisthesis. During surgery, a calcific mass was discovered in the foramen, which was confirmed to be a gout tophus through pathology. The patient’s symptoms resolved postoperatively, indicating the successful removal of the tophus. The article highlights the rarity of gouty depositions compressing the spinal cord and emphasizes the importance of considering patient history in the diagnosis of gouty tophi

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : top treatment hospital on Harley Street UK

Published article

BACKGROUND: Tophaceous gout is a severe form of gout that results in the formation of large nodules, or tophi, in the affected joints and surrounding tissues. Gouty tophi in the spine have a constellation of presentations that often mimic other pathologies and may not be easily discernable from more common pathologic processes.

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J Neurosurg Case Lessons. 2023 Dec 25;6(26):CASE23298. doi: 10.3171/CASE23298. Print 2023 Dec 25.ABSTRACTBACKGROUND: Tophaceous gout is a severe form of gout that results in the formation of large nodules, or tophi, in the affected joints and surrounding tissues. Gouty tophi in the spine have a constellation of presentations that often mimic other pathologies and may,

J Neurosurg Case Lessons. 2023 Dec 25;6(26):CASE23298. doi: 10.3171/CASE23298. Print 2023 Dec 25.

ABSTRACT

BACKGROUND: Tophaceous gout is a severe form of gout that results in the formation of large nodules, or tophi, in the affected joints and surrounding tissues. Gouty tophi in the spine have a constellation of presentations that often mimic other pathologies and may not be easily discernable from more common pathologic processes.

OBSERVATIONS: A 47-year-old female with a history of chronic renal disease, obesity, gout, inflammatory polyarthritis, and multiple sclerosis presented with 6 months of low-back pain and lumbar radiculopathy affecting the right lower extremity. A lumbar magnetic resonance imaging study revealed right foraminal stenosis and spondylolisthesis at levels L4-5. An intraspinal extradural mass was noted adjacent to the traversing right L5 and exiting right L4 nerve roots. A bilateral decompressive laminectomy, facetectomy, and foraminotomy of L4-5 was performed. A calcific, chalky-white mass was discovered in the foramen, and pathology determined the specimen to be a gout tophus. Postoperatively, the patient endorsed the resolution of her preoperative symptoms, which have not returned on follow-up.

LESSONS: Reports of gouty depositions compressing the spinal cord in the current literature are relatively rare. Although the diagnosis of gouty tophi can only be confirmed histologically, patient history may serve as a helpful diagnostic tool.

PMID:38145559 | PMC:PMC10751219 | DOI:10.3171/CASE23298

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Foraminal stenosis and radiculopathy secondary to tophaceous gout: illustrative case

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J Neurosurg Case Lessons. 2023 Dec 25;6(26):CASE23298. doi: 10.3171/CASE23298. Print 2023 Dec 25.ABSTRACTBACKGROUND: Tophaceous gout is a severe form of gout that results in the formation of large nodules, or tophi, in the affected joints and surrounding tissues. Gouty tophi in the spine have a constellation of presentations that often mimic other pathologies and may

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