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Tophaceous gout causing lumbar stenosis: A case report.

ABSTRACT: Gout in the spine is very rare. The clinical symptoms of the spinal gout are various and lack of specificity. The authors report a case of spinal gout causing lumbar stenosis. We never find such wide-invasive spinal gouty lesion in the published studies.A 68-year-old male had low back pain radiating to bilateral lower limbs, accompanying with intermittent claudication that lasted for 3 months and aggravated 5 days ago.Spinal gout, lumbar stenosis.The patient underwent L2-L4 laminectomy, L2/3 L3/4 an d L4/5 discectomy and transforaminal lumbar interbody fusion with pedicle screw fixation.Dual-energy computed tomography detected extensive tophaceous deposits in L1/2 L2/3 L3/4 and L4/5 lumbar discs as well as the posterior column, especially L2-L3 and L4-L5 facet joints. During the surgery, we found a mass of chalky white material at the posterior column of L3 to L5 vertebral bodies, which also involved the intervertebral discs. Pathological examination confirmed the diagnosis of spinal gout.Although spinal gout is thought to be rare, the diagnosis should be considered if the patient had severe back pain and a history of gout. Dual-energy computed tomography is highly recommended for these patients.

SUBMITTER: Lu H

PROVIDER: S-EPMC5556215 | biostudies-other | 2017 Aug

REPOSITORIES: biostudies-other

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Case report of a Gore-Tex TCPC conduit dissection causing severe stenosis.

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Gout and Progression of Aortic Stenosis.

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Significant infrarenal aortic stenosis in pregnancy: a case report.

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Giant lumbar pseudomeningocele after revision lumbar laminectomy: a case report and review of the literature.

Project description:IntroductionIncidental durotomy is a relatively common complication of spine surgery. Prevalence ranges from 3 to 5% in primary and 7 to 17% in revision procedures. Despite this relatively common occurrence the subsequent development of pseudomeningoceles following lumbar spine surgery is reported to be between 0.07 and 2%. Giant pseudomeningoceles (GP) are rare and therefore we report our experience with a case.Case presentationWe report a case of an iatrogenic GP post revision lumbar surgery that extended 19?cm in length. The patient underwent revision L3-S1 laminectomy, laminotomy, excision of pseudomeningocele and successful direct dura repair. Postoperatively, a subcutaneous seroma persisted. This was managed with surgical exploration and prolonged drainage. This led to reduction of the seroma and symptomatic improvement for the patient.DiscussionIncidental durotomy is a relatively common complication of spine surgery and if the durotomy is not addressed at the time of an operation a pseudomeningocele may develop. A pragmatic approach for GP is to individualise management based upon symptoms. Although GP are rare, prevention is likely the best approach. We outlined a structured approach to the management of an incidental dural leak that formed the largest reported pseudomeningocele reported to date.

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