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Medically reversible quadriparesis in tophaceous gout.
Archives of Physical Medicine and Rehabilitation
|March 1, 1985
Summary
A type II odontoid fracture caused by gout stabilized without surgery. Conservative management, including a collar, restored patient strength and independence, proving nonoperative treatment is viable for this rare condition.
Area of Science:
- Orthopedic Surgery
- Rheumatology
- Neurosurgery
Background:
- Odontoid fractures, particularly type II, often require surgical intervention due to instability.
- Tophaceous gout involvement of the cervical spine is rare and can lead to complex fractures.
- Cervical spine instability poses significant risks, including neurological deficits.
Observation:
- A patient with severe tophaceous gout developed a type II odontoid fracture with C1-C2 instability, presenting with spastic quadriparesis.
- The patient refused surgical treatment for the odontoid fracture and associated instability.
- Conservative management with a cervical collar was initiated.
Findings:
- The odontoid process fracture demonstrated significant stabilization following conservative management.
- The patient experienced substantial recovery of strength, regaining independence in self-care and ambulation.
- Nonoperative treatment led to a successful outcome despite the fracture's severity and instability.
Implications:
- This case suggests that conservative management may be a successful alternative for select patients with type II odontoid fractures secondary to tophaceous gout.
- The findings highlight the potential for nonoperative stabilization in cases of cervical spine instability caused by crystal deposition diseases.
- Further research into nonoperative strategies for complex cervical spine fractures in the context of metabolic disorders is warranted.