Three-Phase Bone Scans in Post-Surgery Spinal Gout: Case Report

術後脊柱痛風的三相骨骼掃描：個案報告

莊紫翎(Tzyy-Ling Chuang) ； 劉耿彰(Keng-Chang Liu) ； 曾志恩(Chih-En Tseng) ； 黃光永(Kuang-Yung Huang) ； 王昱豐(Yuh-Feng Wang)

《核子醫學暨分子影像雜誌》 32卷3期 (2019/09) Pp. 145-152

https://doi.org/10.6332/ANMMI.201909_32(3).0004

摘要

Gout results from the deposition of uric acid salts and crystals in and around the joints and soft tissue. Spinal gout is rare, and post-surgery spinal gout is even rarer. We report a case with visually and pathologically proved post-surgery gout in spines following internal fixation and his serial three-phase bone scans. A 55-year-old male received L3/L4 posterior lumbar interbody fusion (PLIF). More than one year later, he had low back pain and was unable to move or stand. Magnetic resonance imaging (MRI, 16 months post-surgery) revealed an infectious process of the L3/L4 disc space (discitis or spondylodiskitis) with extension to the anterior epidural space. The first bone scan (17 months post-surgery) showed intense metabolic activity and increased vascularity in the lower lumbar spine, consistent with clinical manifestations of status post internal fixation with local infection. The patient received antibiotic treatment but experienced recurrent low back pain. The second bone scan (21 months post-surgery) showed increased metabolic activity in the lower lumbar spine without increased blood flow, suggesting status post-internal fixation with a low likelihood of local inflammation/infection. The patient underwent revisional surgery involved L2-L4 posterior debridement and posterolateral fusion with autograft. Intraoperative findings showed tophi-like tissues accumulated around the L3 and L4 pedicles, with loosening of bilateral L3 and L4 pedicle screws. Union of previous L3/L4 posterior interbody fusion was not achieved and L3/L4 segmental instability was apparent. Pathology showed degenerative fibrocartilage with fibrosis and tophus. This case of post-surgery spinal gout showed differences in the two serial three-phase bone scans. After antibiotic treatment, the second three-phase bone scan showed reduced infection. Post-surgery spinal gout is rare and probably caused by the etiology of surgical damage and regional inflammation in our case.

關鍵字

gout ； post-surgery ； spine ； three-phase bone scan ； tophus

並列摘要

痛風是由關節和軟組織內及周圍的尿酸鹽和晶體沉積引起的。脊柱痛風很罕見，術後脊柱痛風甚至更罕見。我們報告一例接受內固定後之視覺和病理證實的術後痛風及他的一系列三相骨骼掃描。一名55歲男性接受第三／第四腰椎後路椎體間融合術（posterior lumbar interbody fusion, PLIF）。一年多以後，他患有腰痛，無法移動或站立。核磁共振（magnetic resonance imaging，術後16個月）顯示三／第四腰椎椎間盤間隙感染（椎間盤炎或脊椎椎間盤炎）並延伸到前硬膜外腔。第一次骨掃描（術後17個月）顯示下腰椎強烈的代謝活性和血流增加，與內固定後局部感染的臨床表現一致。患者接受了抗生素治療，但腰痛仍再發。第二次骨掃描（術後21個月）顯示下腰椎代謝活性增加但血流無增加，暗示內固定後局部發炎／感染的低可能性。患者接受了翻修手術，包括第二到第四腰椎後路清創術和自體移植後外側融合術。術中發現，第三、第四腰椎椎弓根周圍積聚了類似於痛風石的組織，及第三、第四腰椎雙側椎弓根螺釘鬆動。先前第三／第四腰椎後路椎體間融合不良，並且不穩定。病理學顯示退化性纖維軟骨合併纖維化，以及痛風石。此術後脊柱痛風的病例表現出前後兩次三相骨骼掃描的差異。抗生素治療後，第二次三相骨骼掃描顯示感染減少。術後脊柱痛風很少見，而本個案可能是由於手術的損傷和局部發炎所造成的。

並列關鍵字

痛風 ； 術後 ； 脊柱 ； 三相骨骼掃描 ； 痛風石