Severe spinal stenosis, in part due to gout
Sudden quadriplegia in a septicaemic patient. Suspected spinal epidural abscess.
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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.