Spinal gout is a form of gout that affects areas of the spine. Gout is a type of inflammatory arthritis that can occur due to a buildup of uric acid.

If the body is unable to remove excess uric acid, urate crystals can form around joints, causing pain and inflammation. In severe cases, deposits of uric acid can also form under the skin. These deposits are known as tophi.

Without treatment, gout may spread to other areas of the body, including the spine. Spinal gout can cause back pain, weakness, loss of sensation, tingling, and cramping sensations.

This article looks at how spinal gout develops, diagnosis, treatment options, and the outlook for people with the condition.

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According to a 2021 report, spinal gout is a rare form of gout that affects the spine, most commonly the lumbar spine.

The report states that spinal gout may affect 22–35% of people, but many cases may go undiagnosed due to a wide range of symptoms and a lack of awareness around the condition.

Gout is a kind of inflammatory arthritis that can occur due to elevated uric acid levels. Uric acid is a waste product, but if the body is unable to remove it effectively enough, it can build up.

Excess uric acid can form urate crystals around the joints, usually in the lower body, such as the toes, ankles, and knees.

Without treatment, gout may progress into and formation of tophi, which are hard deposits of uric acid that form under the skin, can occur. Over time, tophi may form in other areas of the body, such as the axial skeleton.

The axial skeleton consists of the skull, ribcage, and spinal column. Spinal gout can affect the following:

  • facet joints, which connect vertebrae in the spine
  • lamina, the back arch of the vertebra that connects to the spinal cord
  • ligamentum flavum, the ligament that connects the laminae
  • epidural space, an area within the spinal column

Symptoms of spinal gout may include:

  • back pain
  • neck pain
  • weakness
  • numbness
  • loss of bladder or bowel control
  • reduced sensation in the back, legs, and buttocks

Hyperuricemia is a condition where there is excess uric acid in the body. Uric acid is a waste product from purines, which is a substance found in the body and certain foods.

In some cases, hyperuricemia can lead to gout. High levels of uric acid can build up and form crystals in the joints, tissues, and fluids within the body. These crystals can cause pain and inflammation.

Certain factors may increase the risk of high uric acid levels leading to clinical gout, including:

According to a 2016 review, without treatment, gout may spread to the spine. Gout usually affects joint spaces, so areas of the spine such as facet joints may be susceptible to deposits of urate crystals.

The research also theorizes that high levels of uric acid in the blood may signal an increase in cerebrospinal fluid. This may lead to obstruction areas of the foramen or spinal canal.

According to a 2019 article, spinal gout can be difficult to diagnose because it is a rare condition and currently has no definite diagnostic criteria.

The article suggests signs of spinal gout may include:

  • pain in the axial skeleton
  • pain that radiates from the spine to the hips and legs and may also result in tingling, numbness, or weakness
  • compression in the spinal cord
  • high uric acid levels

A doctor may perform a physical examination to check for nodules around the joints, which could indicate gout.

A doctor may also carry out tests to check muscle strength and reflexes.

A doctor may use a blood test to measure uric acid levels. Uric acid levels above 7 milligrams per deciliter (mg/dl) may indicate hyperuricemia.

Imaging tests, such as MRI scans, may help to show any spinal compression.

Doctors may use biopsy or surgery to check for a white, chalky mass that can indicate urate crystals.

The medications to treat spinal gout are the same as those that treat gout affecting more typical areas.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin or naproxen, can help treat symptoms in acute gout attacks.

NSAIDs may not be suitable for people with certain conditions, such as chronic kidney disease or heart disease. People may take colchicine as an alternative medication.

Long-term treatment may include other medications that work to prevent tophi and lower uric acid levels. These include:

  • xanthine oxidase inhibitors, such as allopurinol, oxypurinol, or febuxostat
  • uricosuric agents, such as sulfinpyrazone and probenecid

Other treatments for gout may include:

  • losing excess weight
  • limiting or avoiding alcohol, particularly beer and hard liquor
  • reducing or avoiding foods high in purines, such as red meat, organ meat, or seafood
  • avoiding any medication that may increase uric acid levels, such as diuretics
  • stay physically active with low-impact exercises, such as walking or swimming

According to a 2019 review, prompt diagnosis and treatment of spinal gout may help to relieve symptoms and prevent the condition from progressing.

In one case study, a person underwent surgery to treat compression in spinal gout, which resulted in significant improvement in radiating pain.

Treatment also included taking colchicine twice a day. In a 3-year follow-up, the person remained symptom-free.

Spinal gout is a rare type of gout that affects areas of the spine.

Although gout usually affects the toes and other joints in the lower body, over time, it can spread to other parts of the body, such as the spine.

Doctors may use blood tests, imaging tests, and biopsies to diagnose spinal gout. Treatment may include medications to reduce inflammation and lower uric acid levels.

If people have any spinal cord compression, they may require surgery.

Prompt diagnosis, treatment, and lifestyle changes may help to relieve symptoms and prevent the condition from progressing.