Tophaceous gout of the spine resulting in cauda equina syndrome: a rare presentation

Introduction: Cauda equina syndrome due to spinal gout is an uncommon presentation of gout. Tophaceous deposits in the spinal canal compressing the nerve roots leads to this condition. 

 

Case Presentation: We report a case of cauda equina syndrome due to spinal gout in a 36-year-old Sri Lankan male who was presented with symptoms for two-month duration. Patient was having radicular pain, urinary and bowel incontinence and erectile dysfunction for two-month duration with saddle anesthesia. Magnetic resonance imaging (MRI) showed cauda equina compression at L5, S1 vertebral levels. Patent underwent laminectomy and it was found to have whitish chalky material compressing the dural sac which was confirmed as tophaceous gouty deposits by histology.  

 

Discussion: Although the success rates are low in delayed surgery for cauda equina syndrome our patient showed improvement of bladder functions and reduction in radicular pain.