Tophaceous Gout of the Lumbar Spine: A Case Report

腰椎痛風性關節炎：一病例報告

李心白(Hsin-Pai Lee) ； 劉思源(Se-Yuan Liu) ； 謝時鵬(Shih-Peng Hsieh) ； 施承貴(Cherng-Gueih Shy) ； 簡言軒(Yen-Hsuan Je)

《童綜合醫學雜誌》 7卷2期 (2013/12) Pp. 70-75

摘要

痛風乃一常見代謝性疾病，但脊椎的痛風仍屬少見，其臨床表徵和脊椎狹窄症併神經根壓迫類似。此病例報告描述一46歲男性罹患全身多處關節如手指、腕、肘部、膝、踝及足部皆有痛風石，另下肢亦有神經壓迫症狀，放射線檢查顯示有腰椎狹窄症，其脊椎痛風性關節炎是在手術中肉眼及組織病理切片証實。該病患經由手術減壓和適當的痛風藥物治療後已達良好的療效。脊椎外科醫師在面對脊椎疾病處置時，應把痛風列入鑑別診斷之一，以達正確的治療。

關鍵字

痛風 ； 脊椎 ； 痛風石 ； 神經根壓迫 ； 外科手術

並列摘要

Although gout is a common metabolic disease, spinal gout is rare. Its clinical manifestation is similar to that of lumbar spinal stenosis with radiculopathy. This case report describes the presentation of spinal gout in a 46-year-old male with a prolonged history of bilateral tophaceous gout of the large and small joints of the hands, wrists, elbows, knees, ankles, and feet, along with neurological abnormalities of the lower limbs. His radiological findings were suggestive of a degenerative process. Spinal gouty arthritis was diagnosed only after the tophi in the facets were detected during surgery and verified in a pathological examination. The histological diagnosis confirmed tophaceous gout. Surgical decompression and the subsequent optimization of pharmacological treatment enabled a good recovery from the neurological complications. Spinal surgeons should consider spinal gout when considering the differential diagnoses of patients with gout and axial pain, with or without neurological deficits.

並列關鍵字

Gout ； spine ； tophi ； radiculopathy ； surgery