Lumbar spinal stenosis induced by rare chronic tophaceous gout in a 29-year-old man

Spinal gout is rare in patients younger than 45 years, occurring most commonly between ages 45 and 80 years. This article describes a 29-year-old man with a history of gout initially observed more than 20 years previously who presented with lower back pain and left lower limb weakness. Computed tomography and magnetic resonance imaging revealed severely damaged facet joints and laminae surrounding L4-S1, and materials with a granular, yellow, cheese-like appearance were observed under direct vision. Postoperative histological examination confirmed spinal gout. Complete posterior decompression was performed concurrently with interbody fusion at L4-L5 and L5-S1. Seventeen-month follow-up revealed good recovery.The mechanism by which urate crystals form preferentially in the spine as opposed to more common soft tissue sites is not well understood. Most reported spinal gout cases were located at L4-S1, which were believed to be the segments with high stresses. These cases occurred in older patients with degenerative spinal diseases and had trauma as indicators. The current authors presume that gout is more likely to exist in the mobile regions with high pressure, such as L4-S1, even in individuals with an initially healthy spine, especially with a long period of abnormal renal dysfunction. Although it is often overlooked in young patients, this condition may be more common than the literature suggests due to the high potential for misdiagnosis in relatively young patients.