背景:脊柱和附件的痛风在临床实践中很少见,也很容易误诊,我们报道了一例由于腰椎管痛风结石导致神经根受压的患者。
方法:一名51岁男性因腰椎疼痛伴左下肢麻木6个月以上入院。体格检查显示L4-S1棘突存在压痛和搏击痛。直腿抬高试验:左侧50°为阳性。实验室检测显示sUA为669μmol/L,腰椎MRI显示,在L4-L5水平的椎管内可见囊性T1WI低信号和T2WI混合高信号阴影。
方法:结合实验室检查,影像学检查,和组织病理学结果,患者被诊断为腰椎管痛风石。
方法:在积极改进所有检查后,患者接受了减压和L4-L5段内固定的手术治疗.
结果:手术后,患者症状改善,肌肉力量恢复正常。在先前报道的95名腰椎痛风患者中,男女比例为2.96:1,发病高峰年龄组为56~65岁.发病主要集中在腰椎的单节段,34.41%的病例发生在L4-L5水平。61.05%的患者有痛风发作或高尿酸血症史,最常见的部位是脚和脚踝,接着是手腕。六十七名病人接受了手术治疗,22人选择保守治疗,总体结果令人满意。
UNASSIGNED:腰痛风的发病率低,在临床上相对罕见,病理活检仍然是金标准。手术治疗常选择椎板切开减压,痛风对椎体的破坏和手术切除范围的合理选择,应综合考虑是否进行融合。无论是选择手术治疗还是保守治疗,应强调控制尿酸水平。
BACKGROUND: Gout in the spine and adnexa is rare in clinical practice and can also be easily misdiagnosed, we reported a patient with nerve root compression due to lumbar gout stones in the lumbar spinal canal.
METHODS: A 51-year-old male was admitted to the hospital with lumbar pain with numbness in the left lower limb for more than 6 months. The physical examination showed that tenderness and percussion pain were present at L4-S1 spinous process. Straight leg raise test: 50° on the left side were positive. Laboratory tests showed that the sUA was 669 μmol/L, MRI of the lumbar spine showed that cystic T1WI low signal and T2WI mixed high signal shadows were seen in the spinal canal at the level of L4-L5.
METHODS: Combining with lab examinations, imaging examinations, and histopathological results, the patient was diagnosed with lumbar spinal canal tophi.
METHODS: After active improvement of all examinations, the patient underwent surgical treatment with decompression and internal fixation of the L4-L5 segment.
RESULTS: After surgery, the patient\'s symptoms improved and muscle strength returned to normal. Among the 95 previously reported patients with lumbar gout, the ratio of men to women was 2.96:1, and the peak age group of incidence was 56 to 65 years. The onset of the disease was mainly in a single segment of the lumbar spine, with 34.41% of all cases occurring at the L4-L5 level. 61.05% of the patients had a history of gout attacks or hyperuricemia, and the most frequently involved site was the foot and ankle, followed by the wrist. Sixty-seven patients underwent surgical treatment, and 22 chose conservative treatment, with overall satisfactory results.
UNASSIGNED: The incidence of lumbar gout is low and relatively rare in the clinic and pathological biopsy is still the gold standard. Vertebral plate incision and decompression are often selected for surgical treatment, and whether to perform fusion should be comprehensively considered for the destruction of vertebral bone by gout and the reasonable selection of the extent of surgical resection. Whether choosing surgical treatment or conservative therapy, the control of uric acid levels should be emphasized.