Case of lumbar spinal stenosis and chronic tophaceous gout

Abstract

Background: Rarely, chronic tophaceous gout can result in lumbar spinal stenosis and neural compression.

Case description: A 67-year-old male presented with the radiographic and magnetic resonance findings of gout involving and causing compression of the lumbar spine that responded to surgical decompression.

Conclusion: It is difficult to diagnose lumbar spinal stenosis secondary to tophaceous gout. Notably, the treatment, based on the clinical presentation, may include both medication and surgical decompression.

Keywords: Joint inflammation; Lumbar spinal stenosis; Multidisciplinary approach; Tophaceous gouty arthritis; Tophi; Urate crystals.

Figure 1:

Clinical photographs of patient’s bilateral feet (a), bilateral hands (b), and front view of the right hand (c) demonstrating multiple tophaceous swellings involving various joints of hands and feet.

Figure 2:

Sagittal views of magnetic resonance imaging lumbosacral spine of the patient showing right sagittal cut (a), midsagittal cut (b), and left sagittal cut (c).

Figure 3:

Axial views of the magnetic resonance imaging lumbosacral spine at (a) L3-4, (b) L4-5, and (c) L5-S1 levels of the patient. The green arrow in (a) is demonstrating the thickening of the spinous process noted at the L3-4 level. The yellow arrow in (b) demonstrates a hyper-intense signal in the left paraspinal region.

Figure 4:

Photograph of the specimen excised intraoperatively demonstrating tophi along with bony tissue.