Thoracic cord compression due to gout: A case report and literature review

An 82-year-old man developed progressive weakness of both legs 1 month prio r to admission. He reported no previous history of trauma. Spine radiograph y revealed marked thoracic and lumbar spondylosis. Magnetic resonance imagi ng of the spine disclosed segmental stenosis with cord compression at TIO-l l due to an extradural soft tissue lesion. Based on a diagnosis of thoracic spondylosis with cord compression, decompression laminectomy was performed . During the operation, fragile chalky-white material was noted over the ep idural space, compressing the thoracic cord. The granular lesion was meticu lously removed until the dura was identified and the cord was decompressed. Histologic examination of the surgical specimen revealed deposits of needl e-like crystals that were consistent with monosodium urate, demonstrating t hat a gouty lesion of the thoracic spine had caused the cord compression. T he patient had previously experienced several attacks of gouty arthritis of his feet. The postoperative serum uric acid concentration was 8.5 mg/dL. A fter surgery, he was treated with benzbromarone 100 mg per day. He was able to walk 3 months after the operation. A high index of suspicion of gouty i nvolvement of the spine is necessary in patients with gout. Surgical decomp ression followed by regular administration of antigout drugs can provide sa tisfactory results.