Orthopaedic Spine Surgeon Virginia Mason Franciscan Health
Introduction: Although various gout-induced spinal pathologies have been described, it is rare to observe this presentation as an initial gout diagnosis, leading to a spinal deformity, with a concomitant infection in neighboring anatomy. We present a unique case of a previously healthy patient presenting with progressively worsening myelopathy, neck pain and severe jaw pain in the setting of a dental abscess and severe focal cervical spinal deformity.
Methods: A 56-year-old healthy female presented with 1 week of severe jaw pain and 1-2 days of worsening swelling of her jaw. She also described mild neck ache for several weeks with worsening balance and tingling in her hands that she contributed to increased stress at work. She presented with several upper motor neuron findings on exam. Imaging studies demonstrated bony erosion of the C3-C6 vertebral bodies with focal kyphosis as well as a grade 2 spondylolisthesis at C3-4 and autofused facet joints at this level. Severe spinal cord compression in the region of the focal kyphotic deformity with signal change within the spinal cord was also observed. Elevated inflammatory markers and white blood cell count were documented.
She initially underwent a laminectomy from C3-7, bilateral facetectomies at C3-4, with placement of C2, T1, and T2 pedicle screws. She was then placed in Halo Traction with 16 pounds of traction. For the next 4 days, 10 additional pounds were added each day. On post-operative day 5, she underwent a C4, C5, and C6 anterior cervical corpectomy, anterior fusion from C3-7, and completion of the of C2-T2 posterior spinal fusion posteriorly.
Results: The patient tolerated surgery very well and stopped taking opioid medications on post-operative day 2. Her jaw pain and swelling had significantly improved with the antibiotics. She was continued on antibiotics until post-operative day 7, when pathology demonstrated infiltration by collections of macrophages responding to deposition of urate crystals in a pattern typical of a gouty tophus.
Conclusion : We present a unique case of a previously healthy patient presenting with progressively worsening myelopathy, neck pain and severe jaw pain in the setting of a dental abscess and severe focal cervical spinal deformity, found to be gout.
