Spondylolisthesis of Lumbar Spine Caused by Pathogenetic Tophaceous Gout

摘要

Tophaceous gout involved the facet joints of lumbar spine is rare and the pathologic spodylolisthesis of lumbar spine, presents with neurologic symptoms secondary to spinal cord or nerve root compression remains sketchy. In this study, we reported a case of 33-year-old male with the history of hyperuricemic gout without appropriate medical attention. The pain in the lower back and left leg radiculopathy was exacerbated over one month. The images of lumbar spine revealed the spodylolytic spondylolisthesis of L5/S1. Enhanced magnetic resonance imaging (MRI) showed paraspinal mass at bilateral side of L4/S1 intrathecal invasion compressing left L5 nerve root. Because of his medial history of Tetralogy of Fallot with congestive heart failure, surgical decompression for lumbar spinal canal stenosis was not recommended. Incision biopsy was performed for confirmed the diagnosis by local anesthesia. Histology of biopsy specimen revealed aggregation of pale amorphous and eosinophilic, fibrillary material surrounded by chronic inflammatory cells, foreign giants cells reaction and fibrosis. The appearance was compatible with gouty tophus. The patient was treated conservatively with non-steroid anti-inflammatory drugs and lumbar corset. The patient was followed for 16 months. Although he still had pain in the low back, but he can return to daily activities now.