Skip to:

Minimally Invasive Excision of Lumbar Tophaceous Gout: Case Report

Pierluigi Vergara MD FRCS,1 Dominic G O'Donovan MBChB FRCPath2

1Department of Neurosurgery, Addenbrooke’s Hospital, Cambridge University Hospital, Cambridge, UK, 2Department of Histopathology, Addenbrooke’s Hospital, Cambridge University Hospital, Cambridge, UK

Abstract

Background

Symptomatic spinal gout is relatively rare. Open laminectomy, with or without fusion, has been so far the standard treatment for symptomatic spinal gout. We describe here the first case of spinal tophaceus gout treated with minimally invasive surgery.

Methods

A 60-year-old patient, morbidly obese, with no previous history of gout, presented with neurogenic claudication due to severe lumbar canal stenosis at L3/4. Surgery was performed through a minimally invasive approach, using tubular retractors. During surgery, an extradural mass with a thin capsule and containing white “chalky” partially calcified material, slightly adherent to and compressing the theca, was removed.

Results

There were no intra- or perioperative complications. Surgery successfully improved the functional status, with a significant increase in walking distance and no residual leg pain or neurogenic claudication. Histopathology confirmed the diagnosis of spinal tophaceous gout.

Conclusions/Level of evidence

Although spinal gout is usually responsive to medical treatment, surgery is often the first line treatment, particularly in patients with neurological deficits. Would surgery be indicated, we believe that minimally invasive surgery can be effective in treating symptomatic spinal tophaceous gout. Level of Evidence: Class IV.

Page Start: 
0
keywords: 
tophaceous gout, tophi, minimally invasive, spine, Lumbar
Volume 11 Proof 50
doi: 
10.14444/proof50