Systematic Reviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Nov 18, 2016; 7(11): 766-775
Published online Nov 18, 2016. doi: 10.5312/wjo.v7.i11.766
Spinal gout: A review with case illustration
Hossein Elgafy, Xiaochen Liu, Joseph Herron
Hossein Elgafy, Xiaochen Liu, Joseph Herron, Department of Orthopedics, University of Toledo Medical Center, Toledo, OH 43614-5807, United States
Author contributions: All the authors contributed in outlining the manuscript, gathering the data, and writing the manuscript.
Conflict-of-interest statement: None of the authors have any financial or other conflicts of interest that may bias the current study.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at hossein.elgafy@utoledo.edu.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hossein Elgafy, MD, MCH, FRCSEd, FRCSC, Department of Orthopedics, University of Toledo Medical Center, 3065 Arlington Avenue, Toledo, OH 43614-5807, United States. hkelgafy@aol.com
Telephone: +1-419-3833515 Fax: +1-419-3833526
Received: April 27, 2016
Peer-review started: April 28, 2016
First decision: July 6, 2016
Revised: August 1, 2016
Accepted: August 17, 2016
Article in press: August 18, 2016
Published online: November 18, 2016
Processing time: 201 Days and 1.5 Hours
Abstract
AIM

To summarize clinical presentations and treatment options of spinal gout in the literature from 2000 to 2014, and present theories for possible mechanism of spinal gout formation.

METHODS

The authors reviewed 68 published cases of spinal gout, which were collected by searching “spinal gout” on PubMed from 2000 to 2014. The data were analyzed for clinical features, anatomical location of spinal gout, laboratory studies, imaging studies, and treatment choices.

RESULTS

Of the 68 patients reviewed, the most common clinical presentation was back or neck pain in 69.1% of patients. The most common laboratory study was elevated uric acid levels in 66.2% of patients. The most common diagnostic image finding was hypointense lesion of the gout tophi on the T1-weighted magnetic resonance imaging scan. The most common surgical treatment performed was a laminectomy in 51.5% and non-surgical treatment was performed in 29.4% of patients.

CONCLUSION

Spinal gout most commonly present as back or neck pain with majority of reported patients with elevated uric acid. The diagnosis of spinal gout is confirmed with the presence of negatively birefringent monosodium urate crystals in tissue. Treatment for spinal gout involves medication for the reduction of uric acid level and surgery if patient symptoms failed to respond to medical treatment.

Keywords: Spinal; Gout; Tophi; Monosodium urate

Core tip: Gout is a common inflammatory arthritis that rarely affects the spine. In such cases, patients may experience back pain, myelopathic symptoms and radiculopathy. Clinical findings are non-specific. Therefore, it is necessary to have an awareness of the diagnosis, especially in patients with a clinical history of gout and/or elevated inflammatory markers and hyperuricemia. While magnetic resonance imaging is the major non-invasive diagnostic method, all suspicious findings on imaging require surgical sampling for pathological confirmation. While typical uric acid lowering medications are first-line therapy, cord compression or continued symptoms may necessitate operative intervention if medications fail.