Concurrent Ankylosing Spondylitis and Tophaceous Gout in Spine Causing Spinal Cord Compression: A Case Report

僵直性脊椎炎併發脊椎痛風石造成脊髓壓迫：病例報告

林佳貞(Chia-Chen Lin) ； 孟乃欣(Nai-Hsin Meng)

《台灣復健醫學雜誌》 39卷4期 (2011/12) Pp. 253-258

https://doi.org/10.6315/2011.39(4)08

摘要

這是一位有僵直性脊椎炎的57歲男性，過去並無痛風的病史，主訴近三個月下肢有漸進性的無力，感覺異常，及大小便失禁。患者接受脊髓減壓手術，並將壓迫物移除，手術報告為痛風石所造成之神經壓迫。我們發現雖然痛風石影響中軸骨骼的機會較少，但是仍為每位背痛患者的鑑別診斷之一，當僵直性脊椎炎與痛風石壓迫脊髓同時並存，由於病患為了治療僵直性脊椎炎而長期服用非類固醇抗發炎藥物，導致痛風的症狀不易被發現，尤其是在脊椎的痛風石。如此造成之併發症十分嚴重。甚至造成嚴重脊神經損傷，無論在有無痛風病史之疑似脊髓損傷患者，都應將痛風石壓迫的原因列為考慮。除了手術治療外，將來也需長期控制血中尿酸並接受復健治療，方可及早恢復生活功能。

關鍵字

脊髓壓迫（spinal cord compression） ； 脊髓損傷（spinal cord injury） ； 神經性膀胱（neurogenic bladder） ； 痛風（gout） ； 僵直性脊椎炎（ankylosing spondylitis）

並列摘要

Ankylosing spondylitis (AS) rarely coexists with tophaceous gout in the spine. We present a case of a 57-year-old businessman with AS who did not have previous history of hyperuricemia or gouty arthritis. He had a three-month history of progressive bilateral lower limb weakness caused by spinal cord compression (rooted on a tophaceous gout), leading to incomplete paraplegia. He received surgical decompressive laminectomy, which removed the hypertrophic ligamentum flavum and tophus in the level of thoracolumbar junction. There was no obvious neurologic recovery after the surgery. We reviewed the incidence, clinical manifestations, and management of the spinal tophaceous gout coexisting with AS. Non-steroidal anti-inflammatory drugs are used widely for symptom control in patients with AS; this may lead to an under-diagnosis of gout because its clinical signs can be masked by the NSAID drugs. Spinal tophaceous gout should then be considered for patients with a history of rheumatic disorder and myeolopathy.

並列關鍵字

spinal cord compression ； spinal cord injury ； neurogenic bladder ； gout ； ankylosing spondylitis