Three-Phase Bone Scans in Post-Surgery Spinal Gout: Case Report

摘要

Gout results from the deposition of uric acid salts and crystals in and around the joints and soft tissue. Spinal gout is rare, and post-surgery spinal gout is even rarer. We report a case with visually and pathologically proved post-surgery gout in spines following internal fixation and his serial three-phase bone scans. A 55-year-old male received L3/L4 posterior lumbar interbody fusion (PLIF). More than one year later, he had low back pain and was unable to move or stand. Magnetic resonance imaging (MRI, 16 months post-surgery) revealed an infectious process of the L3/L4 disc space (discitis or spondylodiskitis) with extension to the anterior epidural space. The first bone scan (17 months post-surgery) showed intense metabolic activity and increased vascularity in the lower lumbar spine, consistent with clinical manifestations of status post internal fixation with local infection. The patient received antibiotic treatment but experienced recurrent low back pain. The second bone scan (21 months post-surgery) showed increased metabolic activity in the lower lumbar spine without increased blood flow, suggesting status post-internal fixation with a low likelihood of local inflammation/infection. The patient underwent revisional surgery involved L2-L4 posterior debridement and posterolateral fusion with autograft. Intraoperative findings showed tophi-like tissues accumulated around the L3 and L4 pedicles, with loosening of bilateral L3 and L4 pedicle screws.