Gouty arthropathy of the axial skeleton causing cord compression and myelopathy.

A 70-year-old Caucasian female with a past medical history of hypertension, chronic renal insufficiency, dyslipidemia, hypothyoidism, anemia, congestive heart failure, recent humeral fracture, and longstanding gout, presented with a one-year history of progressive weakness and falls, increasing “clumsiness” in her hands and weakness of the lower extremities. Bowel and bladder function were intact. On examination, resistance in the lower extremities was reduced, sensation was diminished bilaterally, and hyperreflexia with sustained ankle clonus noted. Computed tomogram (CT) and magnetic resonance imaging (MRI) of the spine (Figures 1 and 2) revealed a bilateral destructive process involving the posterior elements of T1 and T2, centered on the facet joints. There was anterior listhesis of T1 on T2 and increased T2 signal within the spinal cord. She underwent posterior decompression with instrumented fusion. Surgical pathology of the spinal mass was sent for histology and crystal analysis (Figure 3). Monosodium urate crystals were detected. The patient’s deficits gradually improved postoperatively and the management of her gout (Serum Uric Acid [SUA] at presentation 792 umol/L) was optimized. Gouty arthropathy of the axial skeleton is well-described, affecting up to 17% of patients with chronic gout and is typically localized to the sacroiliac joints and the facet joints of spinal