Unilateral biportal endoscopic decompression for thoracic intraspinal gout with ossified ligamentum flavum: a case report and literature review

By
Zhong, Fangling
Huang, Chenxing
Feng, Xiaoteng
Cheng, Zhaojun
Su, Wenjing
Weibo, Yu
Ren, Hui
Chen, Binwei
Jiang, Xiaobing
May 19, 2026
0 min

Frontiers In Surgery

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.