Tophaceous gout of the spine may present with neck or back pain.
Patient selection: neck or back pain
Reasons to suspect:
(1) history of tophaceous gout
(2) hyperuricemia
MRI of the spine:
(1) T1-weighted images: hypointense
(2) T1-weighted images with contrast: heterogeneous and marginally enhancing
(3) T2-weighted images: focally and strongly hyperintense
Tophi may form:
(1) an epidural mass
(2) deposits within intervertebral disc space
(3) deposits in facet joints
(4) deposit in the intradural space
(5) other sites: neural foramina, ligamentum flavum, pedicles, spinal processes
The presence of fever may cause infection to be suspected.
Differential diagnosis:
(1) herniated disc disease
(2) infectious spondylodiscitis (especially if the patient has a site of infection)
If the patient goes to surgery, then tophaceous material with urate crystals will be seen.
