Thoracic spinal cord compression by a gouty tophus. Case report. Review ofthe literature

An unusual case of thoracic spinal cord compression caused by extradural to phaceous deposits is reported in a 59-year-old female with a long-standing history of gout involving the metatarsophalangeal joints. T1 and T2 magneti c resonance images of the spine illustrated an extradural hyperintense sign al extending from T2 to T9. A decompressive laminectomy disclosed a white c aseum-like material in the extradural space, together with a small organize d hematoma. Histologic examination showed areas of amorphous substance cont aining urate crystals surrounded by inflammatory cells, which was diagnosed as a gouty tophus. The patient made an uneventful recovery after surgery. Fifteen similar cases of the literature are reviewed. Although spinal invol vement by gout seems relatively common, a compression of the spinal cord or of the cauda equina in gout patients seems exceptional. The diagnosis shou ld be considered in patients showing a relevant history of gout, but spinal cord compromise may also represent the initial manifestation of the diseas e.