Gout in the Spine: Imaging, Diagnosis, and Outcomes

  • Michael Toprover
  • Svetlana Krasnokutsky
  • Michael H. Pillinger
Crystal Arthritis (MH Pillinger and S Krasnokutsky, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Crystal Arthritis


Gout is characterized by the deposition of monosodium urate crystals and by acute and chronic inflammation in response to crystals so deposited. Multiple case reports and series describe the deposition of monosodium urate in the spine as a rare manifestation of gout, but the actual prevalence of spinal involvement is unknown and likely to be higher than generally anticipated. Here we review the characteristics of 131 previously reported cases of spinal involvement in gout. We focus in particular on the use of imaging modalities and the extent to which they correlate with presenting symptoms and tissue diagnoses. The recent innovation of using dual-energy computerized tomography to identify urate crystal deposition holds promise for reducing the need for surgical intervention and for establishing a true prevalence rate for spinal gout.


Gout Spine Tophus Back pain Dual-energy CT DECT 


Compliance with Ethical Standards

Conflict of Interest

Dr. Pillinger has received grant support from Takeda Inc. and Crealta. He has also served as a consultant for AstraZeneca and Crealta.

Dr. Krasnokutsky and Dr. Toprover has nothing to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Zhu Y, Pandya BJ, Choi HK. Prevalence of gout and hyperuricemia in the US general population: the National Health and Nutrition Examination Survey 2007–2008. Arthritis Rheum. 2011;63:3136–41.PubMedCrossRefGoogle Scholar
  2. 2.
    Kersley GD, Mandel L, Jeffrey MR. Gout: an unusual case with softening and subluxation of the first cervical vertebra and splenomegaly. Ann Rheum Dis. 1950;9:282–304.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.•
    Hou LC, Hsu AR, Veeravagu A, Boakye M. Spinal gout in a renal transplant patient: a case report and literature review. Surg Neurol. 2007;67:65–73. Case report with a literature review of axial gout. In addition to quite large number of cases reviewed, also provided a useful algorithm for approaching a patient with suspected spinal gout. The authors of this study recommended surgical intervention in all patients with neurological symptoms. They also believed that for patients without neurological symptoms, initial workup with MRI followed by biopsy for diagnosis. PubMedCrossRefGoogle Scholar
  4. 4.•
    Konatalapalli RM, Demarco PJ, Jelinek JS, et al. Gout in the axial skeleton. J Rheumatol. 2009;36:609–13. Review of medical records of gout patients looking at those who had CT images of the spine for any reason in the past. Results showed that 9 of 64 (14%) patients had evidence of axial gout on spinal CT. However, only one of those 9 cases had gotten a CT for back pain, raising the question of how common asymptomatic spinal gout may be. PubMedCrossRefGoogle Scholar
  5. 5.
    Saketkoo LA, Robertson HJ, Dyer HR, Virk ZU, Ferreyro HR, Espinoza LR. Axial gouty arthropathy. Am J Med Sci. 2009;338:140–6.PubMedCrossRefGoogle Scholar
  6. 6.
    de Mello FM, Helito PV, Bordalo-Rodrigues M, Fuller R, Halpern AS. Axial gout is frequently associated with the presence of current tophi, although not with spinal symptoms. Spine (Phila Pa 1976). 2014;39:E1531–6.CrossRefGoogle Scholar
  7. 7.•
    Hasegawa EM, de Mello FM, Goldenstein-Schainberg C, Fuller R. Gout in the spine. Rev Bras Reumatol. 2013;53:296–302. Recent review of axial gout from Brazil that highlights the fact that axial gout may be more common than previously thought, and should be considered in patients with longstanding gout who present with acute back pain. The authors advocated for reserving surgery for patients who had failed medical therapy, or those with neurological impairments, and treating everyone else conservatively. PubMedCrossRefGoogle Scholar
  8. 8.
    Adenwalla HN, Usman MH, Baqir M, Zulqarnain M, Shah H. Vertebral gout and ambulatory dysfunction. South Med J. 2007;100:413–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Ahmad I, Tejada JG. Spinal gout: a great mimicker. A case report and literature review. Neuroradiol J. 2012;25:621–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Alarcon GS, Reveille JD. Gouty arthritis of the axial skeleton including the sacroiliac joints. Arch Intern Med. 1987;147:2018–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Arnold MH, Brooks PM, Savvas P, Ruff S. Tophaceous gout of the axial skeleton. Aust N Z J Med. 1988;18:865–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Barrett K, Miller ML, Wilson JT. Tophaceous gout of the spine mimicking epidural infection: case report and review of the literature. Neurosurgery. 2001;48:1170–2. discussion 2-3.PubMedCrossRefGoogle Scholar
  13. 13.
    Beier CP, Hartmann A, Woertgen C, Brawanski A, Rothoerl RD. A large, erosive intraspinal and paravertebral gout tophus Case repot. J Neurosurg Spine. 2005;3:485–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Bonaldi VM, Duong H, Starr MR, Sarazin L, Richardson J. Tophaceous gout of the lumbar spine mimicking an epidural abscess: MR features. AJNR Am J Neuroradiol. 1996;17:1949–52.PubMedGoogle Scholar
  15. 15.
    Bret P, Ricci AC, Saint-Pierre G, Mottolese C, Guyotat J. Thoracic spinal cord compression by a gouty tophus. Case report. Review of the literature. Neurochirurgie. 1999;45:402–6.PubMedGoogle Scholar
  16. 16.
    Buenzli D, So A. Inflammatory sciatica due to spinal tophaceous gout. BMJ Case Rep 2009;2009.Google Scholar
  17. 17.
    Cabot J, Mosel L, Kong A, Hayward M. Tophaceous gout in the cervical spine. Skelet Radiol. 2005;34:803–6.CrossRefGoogle Scholar
  18. 18.
    Cardoso FN, Omoumi P, Wieers G, et al. Spinal and sacroiliac gouty arthritis: report of a case and review of the literature. Acta Radiol Short Rep 2014;3:2047981614549269.Google Scholar
  19. 19.
    Celik SE, Gorgulu M. Tophaceous gout of the atlantoaxial joint case illustration. J Neurosurg Spine. 2005;2:230.PubMedCrossRefGoogle Scholar
  20. 20.
    Chan AT, Leung JL, Sy AN, et al. Thoracic spinal gout mimicking metastasis. Hong Kong Med J. 2009;15:143–5.PubMedGoogle Scholar
  21. 21.
    Chang IC. Surgical versus pharmacologic treatment of intraspinal gout. Clin Orthop Relat Res 2005;106-10.Google Scholar
  22. 22.
    Chhana A, Dalbeth N. The gouty tophus: a review. Curr Rheumatol Rep. 2015;17:19.PubMedCrossRefGoogle Scholar
  23. 23.
    Choi HK, Al-Arfaj AM, Eftekhari A, et al. Dual energy computed tomography in tophaceous gout. Ann Rheum Dis. 2009;68:1609–12.PubMedCrossRefGoogle Scholar
  24. 24.
    Clerc D, Marfeuille M, Labous E, Desmoulins F, Quillard J, Bisson M. Spinal tophaceous gout. Clin Exp Rheumatol. 1998;16:621.PubMedGoogle Scholar
  25. 25.
    Coulier B, Tancredi MH. Articular tophaceous gout of the cervical spine: CT diagnosis. JBR-BTR. 2010;93:325.PubMedGoogle Scholar
  26. 26.
    Dalbeth N, House ME, Aati O, et al. Urate crystal deposition in asymptomatic hyperuricaemia and symptomatic gout: a dual energy CT study. Ann Rheum Dis. 2015;74:908–11.PubMedCrossRefGoogle Scholar
  27. 27.
    Das DS. Intervertebral disc involvement in gout: brief report. J Bone Joint Surg (Br). 1988;70:671.Google Scholar
  28. 28.
    de Parisot A, Ltaief-Boudrigua A, Villani AP, Barrey C, Chapurlat RD, Confavreux CB. Spontaneous odontoid fracture on a tophus responsible for spinal cord compression: a case report. Joint Bone Spine. 2013;80:550–1.PubMedCrossRefGoogle Scholar
  29. 29.
    Dhaese S, Stryckers M, Van Der Meersch H, Terryn W, Van Laecke S. Gouty arthritis of the spine in a renal transplant patient: a clinical case report: an unusual presentation of a common disorder. Medicine (Baltimore). 2015;94:e676.CrossRefGoogle Scholar
  30. 30.
    Dharmadhikari R, Dildey P, Hide IG. A rare cause of spinal cord compression: imaging appearances of gout of the cervical spine. Skelet Radiol. 2006;35:942–5.CrossRefGoogle Scholar
  31. 31.
    Dhote R, Roux FX, Bachmeyer C, Tudoret L, Daumas-Duport C, Christoforov B. Extradural spinal tophaceous gout: evolution with medical treatment. Clin Exp Rheumatol. 1997;15:421–3.PubMedGoogle Scholar
  32. 32.
    Diaz A, Porhiel V, Sabatier P, et al. Tophaceous gout of the cervical spine, causing cord compression. Case report and review of the literature. Neurochirurgie. 2003;49:600–4.PubMedGoogle Scholar
  33. 33.
    Draganescu M, Leventhal LJ. Spinal gout: case report and review of the literature. J Clin Rheumatol. 2004;10:74–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Dubey D, Steen E, Sawhney A, Stuve O. Spinal gout: a rare cause of paraplegia. Neurol India. 2015;63:284–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Duprez TP, Malghem J, Vande Berg BC, Noel HM, Munting EA, Maldague BE. Gout in the cervical spine: MR pattern mimicking diskovertebral infection. AJNR Am J Neuroradiol. 1996;17:151–3.PubMedGoogle Scholar
  36. 36.
    El Sandid M, Ta H. Another presentation of gout. Ann Intern Med. 2004;140:W32.PubMedCrossRefGoogle Scholar
  37. 37.
    Fenton P, Young S, Prutis K. Gout of the spine. Two case reports and a review of the literature. J Bone Joint Surg Am. 1995;77:767–71.PubMedGoogle Scholar
  38. 38.
    Fontenot A, Harris P, Macasa A, Menon Y, Quinet R. An initial presentation of polyarticular gout with spinal involvement. J Clin Rheumatol. 2008;14:188–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Fraser JF, Anand VK, Schwartz TH. Endoscopic biopsy sampling of tophaceous gout of the odontoid process. Case report and review of the literature. J Neurosurg Spine. 2007;7:61–4.PubMedCrossRefGoogle Scholar
  40. 40.
    Funck-Brentano T, Salliot C, Leboime A, et al. First observation of the efficacy of IL-1ra to treat tophaceous gout of the lumbar spine. Rheumatology (Oxford). 2011;50:622–4.CrossRefGoogle Scholar
  41. 41.
    Gines R, Bates DJ. Tophaceous lumbar gout mimicking an epidural abscess. Am J Emerg Med. 1998;16:216.PubMedCrossRefGoogle Scholar
  42. 42.
    Gongidi P, Gough-Fibkins S. Spondyloarthritis: a gouty display. J Radiol Case Rep. 2010;4:13–8.PubMedCentralPubMedGoogle Scholar
  43. 43.
    Hall MC, Selin G. Spinal Involvement in Gout1960.Google Scholar
  44. 44.
    Hasturk AE, Basmaci M, Canbay S, Vural C, Erten F. Spinal gout tophus: a very rare cause of radiculopathy. Eur Spine J. 2012;21 Suppl 4:S400–3.PubMedCrossRefGoogle Scholar
  45. 45.
    Hausch R, Wilkerson M, Singh E, Reyes C, Harrington T. Tophaceous gout of the thoracic spine presenting as back pain and fever. J Clin Rheumatol. 1999;5:335–41.PubMedCrossRefGoogle Scholar
  46. 46.
    Hongli W, Jianyuan J. Re. Axial gout is frequently associated with the presence of current tophi, although not with spinal symptoms. Spine (Phila Pa 1976) 2015;40:587.Google Scholar
  47. 47.
    Hsu CY, Shih TT, Huang KM, Chen PQ, Sheu JJ, Li YW. Tophaceous gout of the spine: MR imaging features. Clin Radiol. 2002;57:919–25.PubMedCrossRefGoogle Scholar
  48. 48.
    Hu HJ, Liao MY, Xu LY. Clinical utility of dual-energy CT for gout diagnosis. Clin Imaging 2015.Google Scholar
  49. 49.
    Jacobs SR, Edeiken J, Rubin B, DeHoratius RJ. Medically reversible quadriparesis in tophaceous gout. Arch Phys Med Rehabil. 1985;66:188–90.PubMedGoogle Scholar
  50. 50.
    Jajic I. Gout in the spine and sacro-iliac joints: radiological manifestations. Skelet Radiol. 1982;8:209–12.CrossRefGoogle Scholar
  51. 51.
    Jegapragasan M, Calniquer A, Hwang WD, Nguyen QT, Child Z. A case of tophaceous gout in the lumbar spine: a review of the literature and treatment recommendations. Evid Based Spine Care J. 2014;5:52–6.PubMedCentralPubMedCrossRefGoogle Scholar
  52. 52.
    Kao MC, Huang SC, Chiu CT, Yao YT. Thoracic cord compression due to gout: a case report and literature review. J Formos Med Assoc. 2000;99:572–5.PubMedGoogle Scholar
  53. 53.
    Kara A, McQuillan P, Dhaliwal G. A multifaceted case. J Hosp Med. 2013;8:267–70.PubMedCrossRefGoogle Scholar
  54. 54.
    Kaye PV, Dreyer MD. Spinal gout: an unusual clinical and cytological presentation. Cytopathology. 1999;10:411–4.PubMedCrossRefGoogle Scholar
  55. 55.
    Kelly J, Lim C, Kamel M, Keohane C, O'Sullivan M. Topacheous gout as a rare cause of spinal stenosis in the lumbar region Case report. J Neurosurg Spine. 2005;2:215–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Kern A, Schunk K, Thelen M. Gout in the area of the cervical vertebrae and the sternoclavicular joint. Röfo. 1999;170:515–7.PubMedGoogle Scholar
  57. 57.
    King JC, Nicholas C. Gouty arthropathy of the lumbar spine: a case report and review of the literature. Spine (Phila Pa 1976). 1997;22:2309–12.CrossRefGoogle Scholar
  58. 58.
    Ko KH, Huang GS, Chang WC. Clinical images: lumbar spondylolisthesis caused by tophaceous gout. Arthritis Rheum. 2009;60:198.PubMedCrossRefGoogle Scholar
  59. 59.
    Ko KH, Huang GS, Chang WC. Tophaceous gout of the lumbar spine. J Clin Rheumatol. 2010;16:200.PubMedCrossRefGoogle Scholar
  60. 60.
    Ko PJ, Huang TJ, Liao YS, Hsueh S, Hsu RW. Recurrent spinal stenosis caused by tophaceous gout: a case report and review of literature. Changgeng Yi Xue Za Zhi. 1996;19:272–6.PubMedGoogle Scholar
  61. 61.
    Komarla A, Schumacher R, Merkel PA. Spinal gout presenting as acute low back pain. Arthritis Rheum. 2013;65:2660.PubMedGoogle Scholar
  62. 62.
    Konatalapalli RM, Lumezanu E, Jelinek JS, Murphey MD, Wang H, Weinstein A. Correlates of axial gout: a cross-sectional study. J Rheumatol. 2012;39:1445–9.PubMedCrossRefGoogle Scholar
  63. 63.
    Koskoff YD, Morris LE, Lubic LG. Paraplegia as a complication of gout. J Am Med Assoc. 1953;152:37–8.PubMedCrossRefGoogle Scholar
  64. 64.
    Krishnakumar R, Renjitkumar J. Tophaceous gout of the spine masquerading as spondylodiscitis. Indian J Med Res. 2013;137:566–7.PubMedCentralPubMedGoogle Scholar
  65. 65.
    Kuo YJ, Chiang CJ, Tsuang YH. Gouty arthropathy of the cervical spine in a young adult. J Chin Med Assoc. 2007;70:180–2.PubMedCrossRefGoogle Scholar
  66. 66.
    Kwan BY, Osman S, Barra L. Spinal gout in a young patient with involvement of thoracic, lumbar and sacroiliac regions. Joint Bone Spine. 2013;80:667–8.PubMedCrossRefGoogle Scholar
  67. 67.
    Lagier R, Mac GW. Spondylodiscal erosions due to gout: anatomico-radiological study of a case. Ann Rheum Dis. 1983;42:350–3.PubMedCentralPubMedCrossRefGoogle Scholar
  68. 68.
    Lam HY, Cheung KY, Law SW, Fung KY. Crystal arthropathy of the lumbar spine: a report of 4 cases. J Orthop Surg (Hong Kong). 2007;15:94–101.Google Scholar
  69. 69.
    Law G, Abufayyah M, Shojania K, Choi H, Nicolaou S, Reid G, et al. Dual energy computed tomography scans of the spine in patients with tophaceous gout. Ann Rheum Dis. 2011;70:152.Google Scholar
  70. 70.
    Leaney BJ, Calvert JM. Tophaceous gout producing spinal cord compression. Case report. J Neurosurg. 1983;58:580–2.PubMedCrossRefGoogle Scholar
  71. 71.
    Lee YA, Lee SH, Yang HI, Hong SJ. Clinical images: aggressive gouty arthritis with concurrent involvement of the ankle and cervical spine. Arthritis Rheum. 2009;60:3581.PubMedCrossRefGoogle Scholar
  72. 72.
    Levin E, Hurth K, Joshi R, Brasington R. Acute presentation of tophaceous myelopathy. J Rheumatol. 2011;38:1525–6.PubMedCrossRefGoogle Scholar
  73. 73.
    Levin MH, Lichtenstein L, Scott HW. Pathologic changes in gout; survey of eleven necropsied cases. Am J Pathol. 1956;32:871–95.PubMedCentralPubMedGoogle Scholar
  74. 74.
    Litvak J, Briney W. Extradural spinal depositions of urates producing paraplegia Case report. J Neurosurg. 1973;39:656–8.PubMedCrossRefGoogle Scholar
  75. 75.
    Lu F, Jiang J, Zhang F, Xia X, Wang L, Ma X. Lumbar spinal stenosis induced by rare chronic tophaceous gout in a 29-year-old man. Orthopedics. 2012;35:e1571–5.PubMedCrossRefGoogle Scholar
  76. 76.•
    Lumezanu E, Konatalapalli R, Weinstein A. Axial (spinal) gout. Curr Rheumatol Rep. 2012;14:161–4. Review of axial gout that discussed clinical features, imaging, pathology, characteristics of patients and treatment options. Authors argued for CT as most definitive non-surgical diagnostic method, with characteristic findings, and also mentioned dual energy CT as a sensitive tool for diagnosis. PubMedCrossRefGoogle Scholar
  77. 77.
    Magid SK, Gray GE, Anand A. Spinal cord compression by tophi in a patient with chronic polyarthritis: case report and literature review. Arthritis Rheum. 1981;24:1431–4.PubMedCrossRefGoogle Scholar
  78. 78.
    Mahmud T, Basu D, Dyson PH. Crystal arthropathy of the lumbar spine: a series of six cases and a review of the literature. J Bone Joint Surg (Br). 2005;87:513–7.CrossRefGoogle Scholar
  79. 79.
    Marinho F, Zeitoun-Eiss D, Renoux J, Brasseur JL, Genestie C, Grenier P. Tophaceous gout of the spine: case report and review of the literature. J Neuroradiol. 2012;39:123–6.PubMedCrossRefGoogle Scholar
  80. 80.
    Marsaudon E, Bouchard C, Langand D. Spinal cord compression due to tophaceous vertebral gout: a case report and literature review. Rev Med Interne. 1999;20:253–7.PubMedCrossRefGoogle Scholar
  81. 81.
    Mekelburg K, Rahimi AR. Gouty arthritis of the spine: clinical presentation and effective treatments. Geriatrics. 2000;55:71–4.PubMedGoogle Scholar
  82. 82.
    Miller JD, Percy JS. Tophaceous gout in the cervical spine. J Rheumatol. 1984;11:862–5.PubMedGoogle Scholar
  83. 83.
    Miller LJ, Pruett SW, Losada R, Fruauff A, Sagerman P. Clinical image. Tophaceous gout of the lumbar spine: MR findings. J Comput Assist Tomogr. 1996;20:1004–5.PubMedCrossRefGoogle Scholar
  84. 84.
    Mrabet D, Monastiri I, Sahli H, et al. Uncommon feature of gout effecting the spine. Tunis Med. 2010;88:966–7.PubMedGoogle Scholar
  85. 85.
    Murphy DJ, Shearman AL, Mascarenhas R, Haigh RC. Lucent lesions of the spine—a case of spinal gout. Age Ageing. 2010;39:660.PubMedCrossRefGoogle Scholar
  86. 86.
    Murshid WR, Moss TH, Ettles DF, Cummins BH. Tophaceous gout of the spine causing spinal cord compression. Br J Neurosurg. 1994;8:751–4.PubMedCrossRefGoogle Scholar
  87. 87.
    Nicolaou S, Liang T, Murphy DT, Korzan JR, Ouellette H, Munk P. Dual-energy CT: a promising new technique for assessment of the musculoskeletal system. AJR Am J Roentgenol. 2012;199:S78–86.PubMedCrossRefGoogle Scholar
  88. 88.
    Niva M, Tallroth K, Konttinen YT. Tophus in the odontoid process of C2. Clin Exp Rheumatol. 2006;24:112.PubMedGoogle Scholar
  89. 89.
    Ntsiba H, Makosso E, Moyikoua A. Thoracic spinal cord compression by a tophus. Joint Bone Spine. 2010;77:187–8.PubMedCrossRefGoogle Scholar
  90. 90.
    Nunes EA, Rosseti AG, Jr., Ribeiro DS, Santiago M. Gout initially mimicking rheumatoid arthritis and later cervical spine involvement. Case Rep Rheumatol 2014;2014:357826.Google Scholar
  91. 91.
    Nygaard HB, Shenoi S, Shukla S. Lower back pain caused by tophaceous gout of the spine. Neurology. 2009;73:404.PubMedCentralPubMedCrossRefGoogle Scholar
  92. 92.
    Paquette S, Lach B, Guiot B. Lumbar radiculopathy secondary to gouty tophi in the filum terminale in a patient without systemic gout: case report. Neurosurgery. 2000;46:986–8.PubMedGoogle Scholar
  93. 93.
    Parikh P, Butendieck R, Kransdorf M, Calamia K. Detection of lumbar facet joint gouty arthritis using dual-energy computed tomography. J Rheumatol. 2010;37:2190–1.PubMedCrossRefGoogle Scholar
  94. 94.
    Peeters P, Sennesael J. Low-back pain caused by spinal tophus—a complication of gout in a kidney transplant recipient. Nephrol Dial Transplant. 1998;13:3245–7.PubMedCrossRefGoogle Scholar
  95. 95.
    Pfister AK, Schlarb CA, O'Neal JF. Vertebral erosion, paraplegia, and spinal gout. AJR Am J Roentgenol. 1998;171:1430–1.PubMedCrossRefGoogle Scholar
  96. 96.
    Popovich T, Carpenter JS, Rai AT, Carson LV, Williams HJ, Marano GD. Spinal cord compression by tophaceous gout with fluorodeoxyglucose-positron-emission tomographic/MR fusion imaging. AJNR Am J Neuroradiol. 2006;27:1201–3.PubMedGoogle Scholar
  97. 97.
    Reynolds Jr AF, Wyler AR, Norris HT. Paraparesis secondary to sodium urate deposits in the ligamentum flavum. Arch Neurol. 1976;33:795.PubMedCrossRefGoogle Scholar
  98. 98.
    Rivero-Garvia M, Rodriguez Boto G, Gutierrez Gonzalez R, Martinez A. [Tophaceous gout causing stenosis of T11-T12]. Med Clin (Barc). 2008;130:479.CrossRefGoogle Scholar
  99. 99.
    Sabharwal S, Gibson T. Cervical gout. Br J Rheumatol. 1988;27:413–4.PubMedCrossRefGoogle Scholar
  100. 100.
    Sakamoto FA, Winalski CS, Rodrigues LC, Fernandes AR, Bortoletto A, Sundaram M. Radiologic case study. Orthopedics. 2012;35:353–437.PubMedCrossRefGoogle Scholar
  101. 101.
    Samuels J, Keenan RT, Yu R, Pillinger MH, Bescke T. Erosive spinal tophus in a patient with gout and back pain. Bull NYU Hosp Jt Dis. 2010;68:147–8.PubMedGoogle Scholar
  102. 102.
    Sanmillan Blasco JL, Vidal Sarro N, Marnov A, Acebes Martin JJ. Cervical cord compression due to intradiscal gouty tophus: brief report. Spine (Phila Pa 1976). 2012;37:E1534–6.CrossRefGoogle Scholar
  103. 103.
    Saripalli K, Baskar S. Tophaceous gouty arthropathy of the lumbar spine. Clin Med. 2014;14:683–4.PubMedCrossRefGoogle Scholar
  104. 104.
    Schorn C, Behr C, Schwarting A. Fever and back pain—a case report of spinal gout. Dtsch Med Wochenschr. 2010;135:125–8.PubMedCrossRefGoogle Scholar
  105. 105.
    Semlali S, El Kharras A, El Fenni J, Chaouir S, BenAmeur M, Akjouj S. Tophaceous gout of the lumbar spine simulating spondylodiscitis: imaging features: a case report. J Radiol. 2008;89:904–6.PubMedCrossRefGoogle Scholar
  106. 106.
    Sequeira W, Bouffard A, Salgia K, Skosey J. Quadriparesis in tophaceous gout. Arthritis Rheum. 1981;24:1428–30.PubMedCrossRefGoogle Scholar
  107. 107.
    Souza AW, Fontenele S, Carrete Jr H, Fernandes AR, Ferrari AJ. Involvement of the thoracic spine in tophaceous gout. A case report. Clin Exp Rheumatol. 2002;20:228–30.PubMedGoogle Scholar
  108. 108.
    Staub-Schmidt T, Chaouat A, Rey D, Bloch JG, Christmann D. Spinal involvement in gout. Arthritis Rheum. 1995;38:139–41.PubMedCrossRefGoogle Scholar
  109. 109.
    Suk KS, Kim KT, Lee SH, Park SW, Park YK. Tophaceous gout of the lumbar spine mimicking pyogenic discitis. Spine J. 2007;7:94–9.PubMedCrossRefGoogle Scholar
  110. 110.
    Taniguchi Y, Matsumoto T, Tsugita M, Fujimoto S, Terada Y. Spondylodiscitis and Achilles tendonitis due to gout. Mod Rheumatol. 2014;24:1026–7.PubMedCrossRefGoogle Scholar
  111. 111.
    Thavarajah D, Hussain R, Martin JL. Cervical arthropathy caused by gout: stabilisation without decompression. Eur Spine J. 2011;20 Suppl 2:S231–4.PubMedCrossRefGoogle Scholar
  112. 112.
    Thornton FJ, Torreggiani WC, Brennan P. Tophaceous gout of the lumbar spine in a renal transplant patient: a case report and literature review. Eur J Radiol. 2000;36:123–5.PubMedCrossRefGoogle Scholar
  113. 113.
    Tkach S. Gouty arthritis of the spine. Clin Orthop Relat Res. 1970;71:81–6.PubMedCrossRefGoogle Scholar
  114. 114.
    Tran A, Prentice D, Chan M. Tophaceous gout of the odontoid process causing glossopharyngeal, vagus, and hypoglossal nerve palsies. Int J Rheum Dis. 2011;14:105–8.PubMedCrossRefGoogle Scholar
  115. 115.
    Tsai CH, Chen YJ, Hsu HC, Chen HT. Bacteremia coexisting with tophaceous gout of the spine mimicking spondylodiscitis: a case report. Spine (Phila Pa 1976). 2009;34:E106–9.CrossRefGoogle Scholar
  116. 116.
    Udayakumar D, Kteleh T, Alfata S, Bali T, Joseph A. Spinal gout mimicking paraspinal abscess: a case report. J Radiol Case Rep. 2010;4:15–20.PubMedCentralPubMedGoogle Scholar
  117. 117.
    Vaccaro AR, An HS, Cotler JM, Ahmad S, Jordan AG. Recurrent cervical subluxations in a patient with gout and endstage renal disease. Orthopedics. 1993;16:1273–6.PubMedGoogle Scholar
  118. 118.
    van de Laar MA, van Soesbergen RM, Matricali B. Tophaceous gout of the cervical spine without peripheral tophi. Arthritis Rheum. 1987;30:237–8.PubMedCrossRefGoogle Scholar
  119. 119.
    Varga J, Giampaolo C, Goldenberg DL. Tophaceous gout of the spine in a patient with no peripheral tophi: case report and review of the literature. Arthritis Rheum. 1985;28:1312–5.PubMedCrossRefGoogle Scholar
  120. 120.
    Vervaeck M, De Keyser J, Pauwels P, Frecourt N, D'Haens J, Ebinger G. Sudden hypotonic paraparesis caused by tophaceous gout of the lumbar spine. Clin Neurol Neurosurg. 1991;93:233–6.PubMedCrossRefGoogle Scholar
  121. 121.
    Vinstein AL, Cockerill EM. Involvement of the spine in gout. A case report. Radiology. 1972;103:311–2.PubMedCrossRefGoogle Scholar
  122. 122.
    Wald SL, McLennan JE, Carroll RM, Segal H. Extradural spinal involvement by gout. Case report. J Neurosurg. 1979;50:236–9.PubMedCrossRefGoogle Scholar
  123. 123.
    Wang LC, Hung YC, Lee EJ, Chen HH. Acute paraplegia in a patient with spinal tophi: a case report. J Formos Med Assoc. 2001;100:205–8.PubMedGoogle Scholar
  124. 124.
    Wazir NN, Moorthy V, Amalourde A, Lim HH. Tophaceous gout causing atlanto-axial subluxation mimicking rheumatoid arthritis: a case report. J Orthop Surg (Hong Kong). 2005;13:203–6.Google Scholar
  125. 125.
    Wendling D, Prati C, Hoen B, et al. When gout involves the spine: five patients including two inaugural cases. Joint Bone Spine. 2013;80:656–9.PubMedCrossRefGoogle Scholar
  126. 126.
    Yamamoto M, Tabeya T, Masaki Y, et al. Tophaceous gout in the cervical spine. Intern Med. 2012;51:325–8.PubMedCrossRefGoogle Scholar
  127. 127.
    Yasuhara K, Tomita Y, Takayama A, Fujikawa H, Otake Y, Takahashi K. Thoracic myelopathy due to compression by the epidural tophus: a case report. J Spinal Disord. 1994;7:82–5.PubMedCrossRefGoogle Scholar
  128. 128.
    Yehia B, Flynn J, Sisson S. Crystal clear. Am J Med. 2008;121:488–90.PubMedCrossRefGoogle Scholar
  129. 129.
    Yen HL, Cheng CH, Lin JW. Cervical myelopathy due to gouty tophi in the intervertebral disc space. Acta Neurochir (Wien). 2002;144:205–7.PubMedCrossRefGoogle Scholar
  130. 130.
    Yen PS, Lin JF, Chen SY, Lin SZ. Tophaceous gout of the lumbar spine mimicking infectious spondylodiscitis and epidural abscess: MR imaging findings. J Clin Neurosci. 2005;12:44–6.PubMedCrossRefGoogle Scholar
  131. 131.
    Yoon JW, Park KB, Park H, et al. Tophaceous gout of the spine causing neural compression. Korean J Spine. 2013;10:185–8.PubMedCentralPubMedCrossRefGoogle Scholar
  132. 132.
    Zheng ZF, Shi HL, Xing Y, Li D, Jia JY, Lin S. Thoracic cord compression due to ligamentum flavum gouty tophus: a case report and literature review. Spinal Cord 2015.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Michael Toprover
    • 1
    • 2
  • Svetlana Krasnokutsky
    • 1
    • 2
  • Michael H. Pillinger
    • 1
    • 2
  1. 1.Division of Rheumatology, Department of MedicineNYU School of Medicine/NYU Hospital for Joint DiseasesNew YorkUSA
  2. 2.Rheumatology Section, Department of MedicineVA New York Harbor Health Care SystemNew YorkUSA

Personalised recommendations