Adjacent segment disease induced by spinal tophus: a case report
Tophus, a hallmark feature of chronic gout, typically develops in the joints of the extremities, skin, and mucosal tissues. Although several case reports have described spinal tophus deposition leading to spinal stenosis and radiculopathy, documented cases of lumbar adjacent segment disease (ASD) ca...
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Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2025.1545557/full |
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| author | Chenglong Wang Hongjun Liu Shuangquan Gong Yu Ye Liqiang Cui Dengshang Liu Sen Li Shiming Xie |
| author_facet | Chenglong Wang Hongjun Liu Shuangquan Gong Yu Ye Liqiang Cui Dengshang Liu Sen Li Shiming Xie |
| author_sort | Chenglong Wang |
| collection | DOAJ |
| description | Tophus, a hallmark feature of chronic gout, typically develops in the joints of the extremities, skin, and mucosal tissues. Although several case reports have described spinal tophus deposition leading to spinal stenosis and radiculopathy, documented cases of lumbar adjacent segment disease (ASD) caused by monosodium urate crystal (MUC) deposition remain exceedingly rare. Here, we report the case of a 56-year-old male who underwent L4-S1 lumbar fusion surgery two years prior for L4-S1 disc herniation with radiculopathy. The patient presented with recurrent low back pain, radiculopathy, and systemic tophus involvement. Magnetic resonance imaging (MRI) T2-weighted sequences revealed a hypointense signal at the posterior margin of the L3 vertebral body, while computed tomography (CT) demonstrated a hyperdense lesion. These radiographic findings suggested dural sac compression and spinal stenosis, though the definitive etiology warranted further evaluation. Surgical intervention involved excision of the L3 posterior lesion and extension of the fusion construct from L4-S1 to L2-S1 based on the existing L4-S1 instrumentation for spinal stabilization. Histopathological examination confirmed extensive MUC deposition. This report details the clinical presentation, imaging characteristics, pathological findings, surgical management, and potential pathogenic mechanisms underlying this rare complication. |
| format | Article |
| id | doaj-art-bcbe9e42992d471895088facd459c482 |
| institution | OA Journals |
| issn | 2296-875X |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Surgery |
| spelling | doaj-art-bcbe9e42992d471895088facd459c4822025-08-20T01:49:16ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2025-05-011210.3389/fsurg.2025.15455571545557Adjacent segment disease induced by spinal tophus: a case reportChenglong Wang0Hongjun Liu1Shuangquan Gong2Yu Ye3Liqiang Cui4Dengshang Liu5Sen Li6Shiming Xie7Spinal Surgery Department, Mianyang Orthopaedic Hospital, Mianyang, Sichuan, ChinaSpinal Surgery Department, Mianyang Orthopaedic Hospital, Mianyang, Sichuan, ChinaSpinal Surgery Department, Mianyang Orthopaedic Hospital, Mianyang, Sichuan, ChinaSpinal Surgery Department, Mianyang Orthopaedic Hospital, Mianyang, Sichuan, ChinaSpinal Surgery Department, Mianyang Orthopaedic Hospital, Mianyang, Sichuan, ChinaSpinal Surgery Department, Mianyang Orthopaedic Hospital, Mianyang, Sichuan, ChinaDivision of Spine Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, ChinaSpinal Surgery Department, Mianyang Orthopaedic Hospital, Mianyang, Sichuan, ChinaTophus, a hallmark feature of chronic gout, typically develops in the joints of the extremities, skin, and mucosal tissues. Although several case reports have described spinal tophus deposition leading to spinal stenosis and radiculopathy, documented cases of lumbar adjacent segment disease (ASD) caused by monosodium urate crystal (MUC) deposition remain exceedingly rare. Here, we report the case of a 56-year-old male who underwent L4-S1 lumbar fusion surgery two years prior for L4-S1 disc herniation with radiculopathy. The patient presented with recurrent low back pain, radiculopathy, and systemic tophus involvement. Magnetic resonance imaging (MRI) T2-weighted sequences revealed a hypointense signal at the posterior margin of the L3 vertebral body, while computed tomography (CT) demonstrated a hyperdense lesion. These radiographic findings suggested dural sac compression and spinal stenosis, though the definitive etiology warranted further evaluation. Surgical intervention involved excision of the L3 posterior lesion and extension of the fusion construct from L4-S1 to L2-S1 based on the existing L4-S1 instrumentation for spinal stabilization. Histopathological examination confirmed extensive MUC deposition. This report details the clinical presentation, imaging characteristics, pathological findings, surgical management, and potential pathogenic mechanisms underlying this rare complication.https://www.frontiersin.org/articles/10.3389/fsurg.2025.1545557/fulltophusadjacent segment diseasemonosodium urate crystal depositionuric acidcase report |
| spellingShingle | Chenglong Wang Hongjun Liu Shuangquan Gong Yu Ye Liqiang Cui Dengshang Liu Sen Li Shiming Xie Adjacent segment disease induced by spinal tophus: a case report Frontiers in Surgery tophus adjacent segment disease monosodium urate crystal deposition uric acid case report |
| title | Adjacent segment disease induced by spinal tophus: a case report |
| title_full | Adjacent segment disease induced by spinal tophus: a case report |
| title_fullStr | Adjacent segment disease induced by spinal tophus: a case report |
| title_full_unstemmed | Adjacent segment disease induced by spinal tophus: a case report |
| title_short | Adjacent segment disease induced by spinal tophus: a case report |
| title_sort | adjacent segment disease induced by spinal tophus a case report |
| topic | tophus adjacent segment disease monosodium urate crystal deposition uric acid case report |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2025.1545557/full |
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