Gout-Induced Cervical Deformity and Progressive Myelopathy Mimicking Infection Requiring Cervical Reconstruction

• Published in: World neurosurgery Vol. 182; pp. 112 - 115
• Main Authors: Louie, Philip K., Kumar, Rakesh, Ruhoy, Steven, Nemani, Venu M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2024
• Subjects: Cervical reconstruction; Cervical spine deformity; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - surgery; Female; Gout; Gout - complications; Gout - diagnostic imaging; Gout - surgery; Humans; Kyphosis - surgery; Middle Aged; Myelopathy mimicking infection; Neck; Spinal Cord Compression - surgery; Spinal Cord Diseases - diagnostic imaging; Spinal Cord Diseases - etiology; Spinal Cord Diseases - surgery; Cervical reconstruction; CT; Cervical spine deformity; Myelopathy mimicking infection; Gout
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2023.11.103

This study describes a rare case where gout, a condition primarily associated with joint inflammation, initially manifested as a progressive cervical kyphotic deformity, mimicking infection and causing myelopathy. The patient, a previously healthy 56-year-old woman, presented with severe jaw pain and a temporomandibular joint abscess, alongside 2 months of worsening balance and arm/hand tingling. Extensive clinical and radiographic assessments revealed a severe cervical kyphotic deformity with bony erosion at multiple vertebral levels, raising suspicion of an infectious cause of compressive myelopathy. The patient underwent an urgent staged surgical intervention involving multilevel cervical decompression and fusion, coupled with cervical deformity correction. Post surgery, she received antibiotics for 7 days, during which pathologic analysis unveiled collections of macrophages reacting to urate crystal deposition in a pattern consistent with gouty tophus. This unexpected diagnosis marked a novel case of undiagnosed gout-induced severe cervical deformity presenting with myelopathic symptoms and successfully managed through cervical spine deformity correction. This report underscores the significance of considering gout as a potential cause when encountering unusual spinal pathologies, especially in cases where gout-related symptoms are atypical. The presented 540-degree surgical approach effectively addressed both the cervical deformity and gout-induced myelopathic symptoms. To the best of our knowledge, this study represents the first documented instance of a patient with undiagnosed gout-induced severe cervical deformity successfully treated through cervical spine deformity correction, emphasizing the importance of vigilance and innovative management approaches in such rare clinical scenarios. As of the 2-year follow-up, the patient exhibited significant symptom improvement and overall well-being.