Gout: A Possible Cause of Lumbal Canal Stenosis. Cases Report in Sub-Saharan Area and Literature Review

Abstract

Introduction: Gout is defined as an arthritic condition resulting from the deposition of monosodium urate crystals in and/or around joints, following long-standing hyperuricemia. This may cause gouty arthritis in joints and tophi in soft tissues. Spinal gout is rare and never mentioned in our context. It can appear as acute back pain, radiculopathy, spinal cord compression, spondylodiscitis or neoplasic/infectious epiduritis. Our aim was to share our surgical experience and proceed of a Literature review. Cases Presentation: Between January and August 2022, two patients male were surgically cared, aged of 42 and 60 years old. The gout was unknown in the youngest and poorly followed in the eldest. There was no past medical history of tuberculosis or immunodeficiency in both. The early diagnosis retained was unspecific lumbar spondylodiscitis due to clinical features: Patients complained both of lower back pain with initial fever. It was of a progressive left L5S1 deficit with erectile defect and dysuria in the first case and a progressive paraplegia without sphincter disorders in the second case. We proceeded with a lumbar laminectomy with a biopsy on both patients. The spinal tophus was ligamentous in one case and arthro-ligamentous in the other. There was a progressive motor recovery from postoperative Day-2 till postoperative Month-1. A probabilistic antituberculosis treatment was promptly initiated postoperatively based on radioclinic features while waiting for histologic proof. The Polymerase Chain Reaction (PCR) of Mycobacterium tuberculosis was negative and the histology was of a chronic calcified osteitis with dense fibrosis in both. The anti-gout treatment was implemented after 15 days with blood test evidence. A rheumatologic follow-up was also initiated and adjuvant physio-therapy. The results were very satisfactory from 4 - 6 months with independent walking. Discussion Conclusion: Spinal Gout may be suggested in 40-male-old faced with any acute rachialgia with neuro deficit with dubious neuro-imaging.