Clinical Report: Unilateral Biportal Endoscopic Decompression for Thoracic Spinal Gout

Overview

This report details a case of a 50-year-old man with thoracic spinal canal stenosis due to ossified ligamentum flavum and concomitant epidural tophaceous gout. The patient was successfully treated with unilateral biportal endoscopy (UBE) and demonstrated significant functional recovery one year post-operatively.

Background

Intraspinal tophaceous gout is a rare condition that can lead to severe neurological deficits due to spinal cord compression. Thoracic spinal stenosis caused by ossification of the ligamentum flavum (OLF) is a common condition that may coexist with this type of gout. Understanding effective treatment options is crucial for improving patient outcomes in such complex cases.

Data Highlights

The patient underwent UBE-assisted decompression and percutaneous pedicle screw fixation, resulting in significant symptom resolution and functional recovery.

Key Findings

• The patient had a 4-year history of gout and presented with severe back pain and neurological deficits.
• Preoperative imaging revealed severe thoracic canal stenosis at T10-T11 due to OLF.
• Intraoperative findings included abundant tophaceous material in the epidural space, confirmed as monosodium urate deposits.
• The patient achieved good functional recovery one year after the surgical intervention.
• UBE is suggested as a minimally invasive option for selected patients with thoracic intraspinal gout.

Clinical Implications

This case highlights the importance of a multidisciplinary approach in managing complex spinal conditions involving gout. Long-term urate-lowering therapy is essential for preventing recurrence and managing symptoms effectively.

Conclusion

UBE may offer a precise and minimally invasive treatment option for patients with thoracic intraspinal gout, emphasizing the need for ongoing management of hyperuricemia.

Related Resources & Content

1. Acta Neurochirurgica, 2023 -- Complications and their prevention in unilateral biportal endoscopy: a systematic review with narrative insights and practical management algorithms
2. Impact of Obesity and Body Mass Index Variability on Clinical Outcomes and Safety in Biportal Endoscopic Lumbar Decompression, 2024
3. Frontiers in Surgery, 2026 -- Clinical outcomes of uni-portal non-coaxial spinal endoscopic surgery versus unilateral biportal endoscopic surgery for lumbar spinal stenosis: a retrospective cohort study
4. 2023 EULAR recommendations on imaging in diagnosis and management of crystal-induced arthropathies in clinical practice - PMC
5. Clinical efficacy and safety of unilateral biportal endoscopy for thoracic ossification of ligamentum flavum: A systematic review - PMC
6. Incidence and Risk Factors of Unintentional Dural Tears in Unilateral Biportal Endoscopic Lumbar Surgery
7. 2023 EULAR recommendations on imaging in diagnosis and management of crystal-induced arthropathies in clinical practice - PMC
8. Clinical efficacy and safety of unilateral biportal endoscopy for thoracic ossification of ligamentum flavum: A systematic review - PMC
9. Clinical efficacy and safety of unilateral biportal endoscopy for thoracic ossification of ligamentum flavum: A systematic review - PubMed