Tophaceous gout can occasionally involve joints of the vertebral column. This may mimic a number of more common conditions.
Gout of the vertebral spine may mimic or cause:
(1) an epidural abscess
(2) a herniated disc with nerve compression
(3) chronic low back pain
(4) compression of spinal cord or cauda equina
On imaging studies a tophus will show intermediate signal intensity with heterogeneous contrast enhancement.
The diagnosis may be suspected if the patient has risk factors for gout or if the patient has tophi elsewhere, but often the diagnosis is not considered until uric acid deposits are seen at surgery.
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