Abstract:

Spinal gout often involves the facet joints and may form tophi in the spinal canal， but the studies about disc tissue involvement and compressing nerves and causing radicular symptoms in the patients were rare. The clinical materials of one spinal gout patient with intervertebral disc involvement and nerve compression were reported， and the relevant literatures were analyzed. The patient， male， 37-year-old， had low back pain accompanied by right lower limb pain and discomfort for 7 years， aggravated for 2 weeks.The patient had a 10-year history of gout with poorly controlled uric acid levels. The physical examination results revealed mild tenderness over the lower lumbar spinous process and paraspinal area， a positive straight leg raise test on the right side， grade Ⅲ muscle strength in the right iliopsoas muscle， and reduced superficial sensation over the lateral right calf. The uric acid level was 292.2 μmol·L?1. The CT examination results showed bone destruction at the lower endplate of the L5 vertebra and the upper endplate of the S1 vertebra， with scattered high-density shadows within the disc. The magnetic resonance imaging （MRI） results revealed L5 and S1 lumbar disc herniation and irregular signal shadows at the lower endplate of L5 and the upper endplate of S1. The initial diagnosis was “lumbar disc herniation， spinal gout， and gout”. The unilateral biportal endoscopic lumbar discectomy was performed. The pathological examination results of the resected disc tissue confirmed the definite diagnosis of spinal gout. The postoperative symptomatic treatment， including pain relief and uric acid reduction， was administered. At the 3-month postoperative follow-up， the patient’s low back pain and lower limb pain had completely resolved. The manifestations of spinal gout are often similar to those of disc herniation and intraspinal space-occupying lesions， and can include low back pain and lower limb pain. MRI examination in the suspected patients is helpful for the early diagnosis and treatment of spinal gout.

Key words: Spinal gout, Unilateral biportal endoscopy, Tophi, Lumbar discectomy, Facet joints, Case report