Severe spinal stenosis, in part due to gout

Case contributed by Dr Yair Glick

Presentation

Sudden quadriplegia in a septicaemic patient. Suspected spinal epidural abscess.

Patient Data

Age: 75 years
Gender: Male

Disc bulge at levels C5/C6 and C6/C7, accompanied by posterior element thickening, causing severe spinal stenosis with pressure on the spinal cord and resultant myelopathy.
Soft tissue edema around the spinous processes at these levels.

Case Discussion

The patient was transferred to the OR anesthetized and ventilated. Full C5 and C6 laminectomy and partial C4 and C7 laminectomy. During C5 laminectomy, there was a caseous discharge, thought to be pus. The ligamentum flavum was markedly thickened. Good spinal cord release achieved. The cord began pulsating.

Bacteriology proved sterile.

Pathology: Sections show amorphous tissue with calcifications and irregular foci of granular material showing mostly rectangular, rhomboid and a few needle-shaped birefringent crystals under polarized light. These findings are consistent with crystal-induced arthropathy.

Of note, aspirate from the patient's knee two weeks prior also yielded urate crystals.

To sum up, the severe stenosis was due to disc herniation and a ligamentum flavum markedly thickened from a deposit of urate crystals within it.

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Case information

rID: 56848
Published: 24th Mar 2019
Last edited: 24th Mar 2019
System: Spine
Inclusion in quiz mode: Included

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