1 case of cervical gout discitis

Gout is a metabolic disease caused by the metabolic disorder of radon, most of which affects the end joints of the body's limbs, and can also invade the spine and cause intervertebral discitistSpinal gout occurs mostly in the lumbar spine, followed by the cervical and thoracic vertebraeGout occurs in the cervical vertebrae is extremely rare,diagnosisdifficulty, gout stone deposit joint protrusions and cartilage final plate is easy to cause bone damage, easy misdiagnosis,clinicalshould pay attention to the identification ofand tumor sacin sisfeofed withinfectionIn May 2018, the hospital admitted 1 case of cervical disc goutdepositing patients, after which the pathology was confirmed as cervical vertebral gout discdiscitis, and theprocess ofdiagnosis and treatment is reported as followscase datapatient, male, 62 years old, was admitted to hospital with neck pain accompanied by pain in his right upper limb and numbness for 1 yearPrevious history of gout for more than 10 years, intermittent oral oral perpreormol, phenyb bromomarlon and nonsteroidal anti-inflammatory drugs, poor uric acid control, limb joints and body surface skin did not see goutAdmission: C4 to 7 tenderness, punch positive; double upper limb feel no obvious abnormality, right upper limb muscle strength slightly weakened, tibia, triceps muscle strength 4-level, right upper limb arm pull test (plus), right intervertebral hole extrusion test (plus), top test (plus), right bicep, triceps reflex esflex active, double-side signs (Hoffman) Laboratory examination: C reactive protein (CRP) 28.6mg/L, erythropoieta (ESR) 48mm/h, Uric acid 488 ?mol/L, white blood cell count 6.93 x 109/L, neutrophil count 4.27 x 109/L, neutrophil ratio 61.6% Imaging examination: cervical vertebral disc CT flat sweep C4/C5/C6/C7 intervertebral disc protrusion, C6 level post-turret cruciate ligament bone, C5 to 7 vertebrae leading edge visible "bird beak-like" bone, end plate scattered in the circular worm erosion bone damage (Figure 1 A-c); cervical vertebral MRI shows C6 upper edge local bone depression, signal increase, C4/C5/C6/C7 intervertebral disc protrusion, the corresponding horizontal epidural sac and cervical myelin leading edge pressure, C5 to 7 level semal nerve root pressure (Figure 1d, e) The Pain Visual Simulation Scale (VAS) scored 7 points for the neck and 8 for the upper right limb The electromyography suggests the electrical physiological changes of nerve-induced injury in the upper limbs, which are mainly the stem and C7 nerve roots in the right arm diagnosis is cervical vertebral disc protrusion, cervical vertebral post-spinal ligament osteria and C5-7 vertebral final plate bone damage patients were admitted to the hospital to give nonsteroidal anti-inflammatory drugs and cervical traction and other treatment, the effect is general In May 2018, surgery was performed, general anaesthetic pre-cervical C4/C5 disc removal, intervertebral zero-cut bone fusion, C6 vertebral sub-total excision, C5/C6/C7 section titanium mesh bone fusion In surgery to cut the fiber ring, with myelin clamps C5/C6/C7 intervertebral disc and myelin core removal, after surgery X-ray film showed a good fixed position (Figure 1f, g), the removed tissue visible white sand granular tissue (Figure 1h) The results of the pathology examination of intervertebral disc and white sand granulated tissue showed that local inflammatory cells were immersed and dot calcified lesions around soft tissue, which were consistent with the pathological changes of gout (Figure 1i) After surgery, patients with low-level diet, to anti-inflammatory, uric acid excretion and other treatment, the second day wearing neck support off the bed activities, after surgery neck pain and right upper limb pain significantly alleviated, the operation effect is good After the patient was discharged from the hospital did not return to the hospital for review, telephone follow-up, the symptoms of the relief is obvious discussion patients with no tumor and infection history, tumor markers negative, after excluding spinal tumors and infections, consider urate deposition caused by vertebral final plate bone damage, during surgery to detect a large number of white sand granular tissue in the disc, postoperative pathological slicing in line with gout changes, therefore, comprehensive consideration can be confirmed The formation of gout in the patient's vertebral gap may be involved in the process of degenerative disc degenerative change and final vertebral bone damage, which ultimately leads to intervertebral disc protrusion and intervertebral instability Therefore, when gout patients have cervical vertebral disease symptoms and signs, imaging examination show vertebral end plate scattered in the circular bone damage, the corresponding section is "bird's mouth-like" bone and other vertebral instability, and combined with uric acid increase and other parts of the body gout, should be highly suspected of cervical vertebral gout discitis spinal gout can occur in any vertebral, joint protrusion or jaundice tissue, which may be related to spinal injury and degenerative changes, secondary uric acid crystaldeposits 35% of patients with spinal gout have a history of gout for 3 years and are taking irregular medications King and others believe that urate crystallization will cause damage to joints and bones, accelerate the degenerative change of the intervertebral disc, resulting in unstable sections The history of gout history and the signs of ostitexinal wind can be used as one of the diagnostic criteria Jegapragasan et al believe that for patients with low back pain or lower limb pain numbness, if previously diagnosed as gout, especially accompanied by gout at the skin joints, diagnosis in considering common diseases of the spine, but also should consider the possibility of gout-based spinabitis At present, the diagnostic standard for spinal gout is still histopathological examination Laboratory tests almost always showed an abnormal increase in healypoic acid Imaging checks include X-rays, MRI, and CT X-rays are usually non-specific, and MRI diagnoses a high rate of spinal gout, but lacks specificity It has been reported that the spinal gout tissue in the T1 weighted image is low or isometric signal, T2 weighted image is low or equal or high signal, and enhanced MRI is an uneven or uniform enhancement signal In this case, the MRI showed local bone depression on the upper edge of the C6 vertebrae, decreased T1 weighted image signal, and T2 weighted image signal increased, which was consistent with the performance of gout-based spinabitis CT is shown as vertebral, vertebral plate or joint bursts "drillchi-like" bone-soluble bone damage, in this case the patient's cervical CT discendia end plate scattered in the "worm erosion-like" round bone damage In summary, the imaging of spinal gout is complex, lacking specificity, can only be used as a diagnostic reference, lack of decisive significance Dual-energy dual-source CT (DECT) is a new imaging examination technology that appears in recent years, which can clearly display the crystallization of urate, clarify the sedimentary site of tissue pathological products, provide a new way for the diagnosis of gout, and has important value in the early screening of gout , and some scholars have comparative analysis The diagnostic value of common CT and DECT on joint goute deposit seamount was found to be significantly higher than ordinary CT, and the sensitivity and specificity of DECT-identifying gout were 91.9% and 85.4%, respectively, which can be used as a routine examination item for gout screening the current literature on spinal gout is found only in scattered case reports, and is difficult to confirm simply through clinical symptoms and signs, imaging and laboratory examination, clinical diagnosis usually relies on intraoperative detection of white sand granular tissue and postoperative pathological examination confirmed Draganescu et al believe that the body's high uric acid status will accelerate the deposition of uric acid, whether surgery or not, patients need to take uric acid reduction drugs Yu Yunlong and other reported surgery surgery surgery 1 case of L4/L5 gout discitisandis and L4 vertebrae slip off the sciatic nerve affected patients, after surgery nerve function significantly improved Dh?te and others emphasize that spinal gout should pay particular attention to early drug therapy, long-term standardized medication can cause spinal gout gradually disappear To sum up, spinal gout should be diagnosed early and treated early, non-surgical treatment can be used for non-surgical treatment, nonsteroidal anti-inflammatory drugs, alkaline urine and uric acid drugs; reviewed past reports, most patients with spinal gout to take surgical treatment to fully reduce stress, with postoperative drug treatment, the effect is ideal Combined with the author's clinical experience, such as patients have a history of gout, abnormal lysic acid after admission, and ESR, CRP high, CT examination found that the vertebral final plate has bone erosion damage, MRI signal abnormality, after the elimination of spinal infection and tumor, should be highly suspected of gout-based spina;