Spinal gout: A review with case illustration

Table 1 List of patient cases of spinal gout in the literature since 2000

No.	Year	Ref.	Age/sex	Site	Sx/Signs	Duration	Hx Gout	Tophi	Relevant Hx	Hi Urate	MRI T1	T2	Gad	Tx
1	2000	Kao et al[5]	82 M	T10-T11	LE weakness	1 mo	Y	NA	NA	Y	Iso	Hypo	NA	T9-T11 lamina
2	2000	Mekelburg et al[6]	60 M	L2-3	Back pain	5 mo	Y	NA	NA	Y	NA	NA	NA	Cervical lamina
3	2000	Paquette et al[7]	56 M	L3	Back pain, radicular pain	6 yr	N	NA	Arthritis	NA	NA	Hypo	NA	Surgery
4	2000	Thornton et al[8]	27 M	L3-L4	Back pain	1 d	Y	NA	RT	Y	Hypo	NA	Y	Medical NOS
5	2001	Barrett et al[9]	70 M	L5-S1	Back pain, radicular pain, fever	2 d	Y	NA	RI	N	NA	Hyper	Y	Lamina
6	2001	St George et al[10]	60 M	T1-T2	LE weakness, BBD	6 wk	Y	N	NA	NA	NA	Hypo	NA	T1-T2 lamina
7	2001	Wang et al[11]	28 M	T9-T10	LE weakness	1 d	Y	N	NA	NA	NA	NA	NA	T9-T10 lamina
8	2002	Hsu et al[12]	72 M	L4-S1	Back pain, radicular pain	18 mo	Y	NA	NA	Y	Hypo	Hyper	Y	Lamina
9	2002	Hsu et al[12]	77 M	L3-L5	Back pain, radicular pain	12 mo	N	NA	NA	Y	Hypo	Hypo	Y	Lumbar lamina
10	2002	Hsu et al[12]	83 M	T9-T11	LE weakness	1 mo	Y	NA	NA	N	Hypo	Hypo	Y	Lamina
11	2002	Hsu et al[12]	27 M	L2-S1	Back pain	6 mo	Y	NA	NA	Y	Hypo	Hyper	Y	Medical NOS
12	2002	Souza et al[13]	49 M	T9-T10	Back pain, LE weakness	6 mo	Y	NA	NA	NA	Iso	Hypo	Y	T9-T11 lamina
13	2002	Yen et al[14]	68 M	C4-C5	Quadriparesis	2 wk	Y	NA	RI	Y	Hypo	Hypo	NA	Surgery
14	2003	Diaz et al[15]	74 M	C4-C5	Quadriparesis	1 wk	Y	Y	NA	Y	NA	NA	NA	C4-C5 lamina
15	2004	Draganescu et al[16]	48 F	L4	Radicular pain	1 d	Y	Y	Diuretic	Y	NA	Hetero	Y	L4-L5 lamina
16	2004	El Sandid et al[17]	32 M	T7-T9	Back pain, fever	Acute	Y	NA	NA	Y	NA	NA	NA	Lamina
17	2004	Nakajima et al[18]	39 M	L4-5	Low back pain	NA	Y	Y	Arthritis	Y	NA	NA	Y	Medical
18	2005	Beier et al[19]	29 M	L4-L5	Back pain, L5 radiculopathy	Acute	N	N	NA	Y	NA	NA	NA	L4-L5 lamina
19	2005	Celik et al[20]	48 M	C1-C2	Neck pain, radiculopathy, paresthesias	2 mo	N	Y	Alcohol	Y	Hypo	Hyper	Y	Medical NOS
20	2005	Chang[21]	60 M	L3-L4	B/L L4 radiculopathy	NA	Y	NA	NA	Y	Hypo	Hypo	Y	Surgery
21	2005	Chang[21]	72 M	L4-S1	Back pain, claudication	2 wk	Y	NA	NA	Y	Hypo	Hypo	Y	Surgery
22	2005	Chang[21]	66 F	L4-L5	Back pain, claudication	1 mo	Y	NA	NA	Y	Hypo	Hypo	Y	Surgery
23	2005	Chang[21]	63 M	L3-S1	Back pain, claudication, fever	2 wk	NA	NA	NA	N	Hypo	Hypo	Y	Surgery
24	2005	Kelly et al[22]	56 F	L4	Back pain, LE weakness	1 mo	Y	NA	RA, DM, RI	NA	Iso	Hypo	Y	L4-L5 lamina
25	2005	Mahmud et al[23]	47 M	L4-L5	Radiculopathy	3 mo	Y	NA	NA	Y	NA	NA	NA	L4-L5 lamina/facet
26	2005	Mahmud et al[23]	71 F	L4-L5	Back pain, radiculopathy	4 mo	N	NA	NA	N	NA	Hetero	NA	L4-L5 lamina/fusion
27	2005	Mahmud et al[23]	58 M	L4-L5	Back pain, claudication	6 mo	N	NA	NA	N	NA	Hyper	NA	L5 lamina
28	2005	Wazir et al[24]	66 F	C1-C2	Chronic neck pain, A-A subluxation, quadriparesis	2 mo	N	N	Arthritis	Y	NA	NA	NA	Lamina/fusion
29	2005	Yen et al[25]	65 F	L5-S1	Back pain, LE weakness	10 mo	N	NA	NA	NA	Iso	Hetero	Y	L5-S1 lamina
30	2006	Dharmadhikari et al[26]	66 F	C3-C7	Cord compression, quadriparesis, falls	2-3 mo	N	N	NA	NA	Hypo	Hypo	N	C3-C6 vertebrectomy
31	2006	Hou et al[27]	37 M	L5-S1	Back pain, fever	5 d	Y	N	RT	Y	Iso	Iso	Y	Medical NOS
32	2006	Oaks et al[28]	32 M	T5-T8	Back pain, myelopathy	NA	Y	NA	NA	NA	Hetero	Hetero	Y	Lamina
33	2006	Pankhania et al[29]	68 M	C4-C5	Neck pain, quadriparesis, sensory dysfunction	1 mo	N	N	NA	N	Iso	Hetero	Y	Lamina
34	2006	Popovich et al[30]	36 F	T2-T9	Paraplegia	2 wk	Y	NA	NA	Y	Hypo	Hypo	Y	T5-T7 lamina
35	2007	Adenwalla et al[31]	77 M	L5-S1	Severe low back pain, LE weakness	1 wk	N	N	Diurectic	Y	NA	NA	NA	Prednisone and colchicines
36	2007	Lam et al[32]	65 M	L3-L4	LE pain and numbness, BBD	Acute	Y	Y	RI	Y	NA	NA	NA	L3-L4 lamina
37	2007	Lam et al[32]	63 M	L4-S1	Chronic LE pain and paresthesia, claudication	1 yr	Y	N	NA	N	NA	NA	NA	L4-L5 lamina/fusion
38	2007	Suk et al[33]	55 M	L4-L5	Back pain, LE weakness and paresthesia, fever	1 wk	N	N	Alcohol	Y	Hypo	Hetero	Y	L4-L5 lamina/fusion
39	2008	Fontenot et al[34]	85 F	L3-L4	Low back pain	2 mo	N	N	Diuretics	Y	NA	Hyper	NA	Prednisone and colchicines
40	2009	Chan et al[35]	76 M	T8, T10	LE weakness		Y	Y	NA	Y	Iso	Hetero	NA	Medical NOS
41	2009	Nygaard et al[36]	75 M	L4-L5	Low back pain, fever	5 d	Y	N	NA	Y	NA	NA	NA	NA
42	2009	Tsai et al[37]	64 F	T8-T9	Fever, low back pain, LE weakness	1 d	N	N	DM, RI	N	Hypo	Iso	Y	T8-T9 discectomy and partial corpectomy
43	2010	Coulier et al[38]	62 F	C6-C7	Neck pain	NA	N	Y	NA	Y	NA	NA	NA	NA
44	2010	Ko et al[39]	63 M	L5-S1	Low back pain	2 mo	N	N	NA	Y	Hypo	Hypo	Y	Lamina
45	2010	Murphy et al[40]	82 M	NA	Back pain	3 mo	N	Y	NA	NA	NA	NA	NA	NA
46	2010	Ntsiba et al[41]	43 M	T9-T10	Spastic paraplegia	6 mo	Y	Y	Alcohol	NA	Hypo	Hyper	NA	T10 lamina
47	2010	Samuels et al[42]	75 M	L5-S1	Low back pain, radiculopathy, b/l groin pain	Acute	Y	N	DM, RI, arthritis	NA	NA	NA	NA	Steroid injection and allopurinol
48	2011	Ibrahim et al[43]	70 F	T1-T2	UE and LE weakness	1 yr	Y	N	RI	Y	Hypo	Hyper	NA	Lamina/fusion
49	2011	Levin et al[44]	34 M	T2-T5	Paraplegia	Acute	Y	N	RI, DM	Y	NA	NA	NA	Lamina
50	2011	Thavarajah et al[45]	57 M	C1-C2	Neck pain, UE and LE tingling	1 yr	Y	N	NA	NA	NA	NA	NA	C0-C6 fusion
51	2011	Tran et al[46]	73 M	C1-C2	CN IX, X, XII palsies, fever, cough,	3 d	Y	Y	RI	Y	NA	Hetero	NA	Allopurinol, rasburicase
52	2012	Federman et al[2]	66 M	C4-C6	Neck pain	4 mo	N	N	DM	Y	Hypo	Hetero	NA	Allopurinol, colchicine, narcotic analgesics
53	2012	Hasturk et al[4]	77 F	L4-L5	Low back pain, radiculopathy	5 mo	N	N	NA	N	Hypo	Hypo	Y	Surgery
54	2012	Sakamoto et al[3]	69 M	L1-L2	Back pain, radiculopathy	Acute	N	N	Heart Failure	Y	Hypo	Hypo	Y	Medical NOS
55	201	Yamamoto et al[47]	58 F	C4-C7	Malaise, fever, back pain	3 yr	N	Y	Arthritis, RI	Y	NA	NA	NA	Prednisolone, allopurinol, benzbromarone
56	2012	Lu et al[48]	29 M	L4-S1	Severe pain, paresthesia, acratia of LLE	3 yr	Y	Y	Chronic alcohol abuse, chronic gout	Y	Hypo	Hypo	NA	L4-L5/L5-S1 decompression/fusion
57	2012	Sanmillan et al[49]	71 M	C3-C4	Progressive Quadriparesis	4 mo	Y	Y	Hypertension, dislipidemia	Y	Hypo	Hyper	NA	C3-C4 microdiscectomy/fusion
58	2013	Wendling et al[50]	54 M	C5-C6	Inflammatory neck pain and cervicobrachial neuralgia	Acute	Y	N	Hyperch- olesterolemia	Y	Hypo	NA	Y	Colchicine
59	2013	Wendling et al[50]	52 F	Lumbar posterior facet joint	Low back pain	NA	N	Y	Polychondritis	N	NA	NA	NA	Surgery
60	2013	Wendling et al[50]	72 M	C5-C6	Acute neck pain, knee arthritis	Acute	Y	N	Hypertension	Y	NA	NA	NA	Colchicine
61	2013	Wendling et al[50]	65 M	L4-L5	Inflammatory low back pain	Acute	Y	Y	Cardio- myopathy, hypertension	Y	NA	NA	NA	Colchicine
62	2013	Wendling et al[50]	87 M	L3-L5	Inflammatory low back pain	Acute	N	Y	Hypertension, heart failure, chronic kidney failure	Y	Hypo	NA	Y	Colchicine
63	2013	Komarla et al[51]	69 F	L3-S1	Back pain, fever	Acute	N	Y	Alchohol abuse, chronic low back pain	N	NA	Hyper	NA	Allopurinol, colchicine, glucocorticoids
64	2013	de Parisot et al[52]	60 M	C1-C2	Walking disorders, urinary and bowel incontinence	6 mo	Y	Y	NA	Y	Hypo	Hyper	Y	C1-C2 Arthrodesis
65	2013	Kwan et al[53]	25 M	T9-T10, L3-S1	Pain, swelling, and decreased ROM in multiple joints	1 wk	N	Y	CKD	Y	Hypo	Hetero	NA	Prednisone, allopurinol
66	2013	Yoon et al[54]	64 M	T5-T7	Weakness B/L LE, back pain rad to left anterior chest, paraparesis	Weakness: 1 wk; back pain 1 mo	Y (8 yr ago)	Y	Acute gout arthritis 8 yr prior	Y	Hypo	Hetero	Y	T5-T7, laminectomy, facetectomy, pedicle screw fixation w/PL fusion
67	2013	Jegapragasan et al[55]	24 M	L4-S1	Progressively worsening LBP w/rad, weakness of RLE, fever	3 yr LBP rad lat thight	Y (4 yr Hx)		4 yr Tophaceous gout, CKD, 3 yr LBP, rad pain down later thigh (Rt > Lf)	Y	Iso	Hetero	NA	Decompressive laminectomy L4-S1, resection of intraspinal canal and perineural lesion; post-op: colchicine, allopurinol, brief burst of prednisone
68	2014	Cardoso et al[56]	69 W	L4-5, SI joints	LBP rad to buttocks and hips, low fever	NA	N	Y	Constrictive pericarditis, chronic renal insufficiency, HTN, DM	Y	Hypo	Iso	Y	Colchicine, allopurinol

M: Male; F: Female; Sx: Symptoms; Hx: History; RT: Renal transplant; Hi: High; R: Right; LE: Lower extremity; RI: Renal insufficiency; BBD: Bowel/bladder dysfunction; Y and N: Yes and no; Hypo: Hypointense; Iso: Isointense; Hyper: Hyperintense; Hetero: Heterointense; UE: Upper extremity; Lamina: Laminectomy; Tx: Treatment; Gad: Gadolinium.

Table 2 Clinical features

No. of patients
Localized back/neck pain	47
Spinal nerve root compression, in general	14
Radicular pain	6
Radiculopathy NOS	8
Spinal cord compression, in general	38
LE weakness	19
Quadriparesis	6
Claudication	5
Paraplegia	4
BBD	3
Myelopathy NOS	1
Cranial nerve palsy	1
Atlanto-axial subluxation	2
Fever	13

NOS: Not otherwise specified; UE: Upper extremity; LE: Lower extremity; BBD: Bowel/bladder dysfunction.

Table 3 Anatomic location of spinal gout

No. of patients
Lumbar spine	38
Thoracic spine	15
Cervical spine	15
Not mentioned	1
Total1	68

¹Patient No. 65 had gout in two sites, thoracic and lumbar regions.

Table 4 Laboratory studies

No. of patients
Elevated uric acid	45
Elevated ESR	17
Elevated CRP	19
Renal insufficiency	11
Leukocytosis	9
Anemia	5

ESR: Erythrocyte sedimentation rate; CRP: C-reactive protein.

Table 5 Imaging studies

No. of patients
X-ray
Not performed	37
Spondylosis/-listhesis	12
Bony erosion	8
Unremarkable	6
Degenerative changes	5
CT
Not performed	35
BE and HDA	13
BE only	13
Lytic lesions	5
Unremarkable	2
MRI
T1
Not reported	28
Hypointense	31
Isointense	8
Heterointense	1
T2
Not reported	24
Hypointense	18
Heterointense	12
Hyperintense	11
Isointense	4
Gadolinium enhancement
No	36
Yes	32

BE: Bony erosion; HAD: High density attenuation; CT: Computed tomography; MRI: Magnetic resonance imaging.

Table 6 Treatment

No. of patients
Laminectomy only	24
Nonsurgical treatment	20
Surgery not specified	7
Laminectomy and fusion	5
Not reported	3
Fusion only	2
Laminectomy and facetectomy	3
Laminectomy and facetectomy and fusion	1
Vertebrectomy	1
Discectomy and partial corpectomy	2
Total	68