Tophaceous Gout of the Cervical Spine Mimicking Intervertebral Disc Herniation

Tophaceous gout involving the intervertebral disc is rare and may present with neurologic symptoms secondary to spinal cord or nerve root compression. We report a case of a 50-year-old male with a history of hyperuricemic gout who received intermittent medical treatment and had a history of alcoholism. Quadriparesis developed over a period of one month. Magnetic resonance imaging of the cervical spine revealed intervertebral disc bulging at the C3-4 and C5-6 levels. Anterior discectomies with fusion of C3-4 and C5-6 were performed; a chalky-white, granular material was noted in the C3-4 and C5-6 disc spaces. Pathologic examination demonstrated deposits of needle-like crystals surrounded by histiocytes and multinucleated giant cells, with an appearance that was compatible with gout. The patient was independently ambulatory one month after the operation. The clinical and diagnostic features of tophaceous gout of the spine are reviewed. Correspondence Author to: Kwok-Kuen Pang Department of Radiology, Mackay Memorial Hospital, Taitung Branch, Taitung, Taiwan No. 1, Lane 303, Chang-Sha Street, Taitung 950, Taiwan J Radiol Sci 2011; 36: 73-78 Cervical spinal tophaceous gout 74 J Radiol Sci March 2011 Vol.36 No.1 (Fig. 1). Non-enhanced magnetic resonance imaging (MRI) showed segmental narrowing of the thecal sac at the C3-4 and C5-6 levels due to hypertrophic spurs and bulging discs (Fig. 2a, 2b). Axial view MRI showed severe narrowing of the thecal sac at the C3-4 and C5-6 levels (Fig. 2c, 2d). Cervical disc herniation with cord compression was diagnosed. He was referred to the neurosurgery department for surgical intervention. Anterior microdiscectomies of C3-4 and C5-6 with interbody fusion were performed. During the operation, some chalky-white, granular friable material was found in the C3-4 and C5-6 disc spaces and overlying the posterior longitudinal ligament (Fig. 3). Histology of a formalinized specimen revealed multiple nodules of amorphous substance separated and encased by fibrotic tissue and foreign body giant cells (Fig. 4). The appearance was compatible with gout. He was prescribed 100 mg of benzbromarone daily for treatment of hyperuricemia postoperatively. The patient was able to ambulate independently one month following surgery.