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Crystal arthropathy of the lumbar spine

A SERIES OF SIX CASES AND A REVIEW OF THE LITERATURE

Trauma Unit, The John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK.

D. Basu, D. Orth, FRCS, Orthopaedic Registrar; and P. H. P. Dyson, BSc, MCh(Orth), FRCS, Consultant Orthopaedic Surgeon

Department of Orthopaedics, Hemel Hempstead Hospital, Hillfield Road, Hemel Hempstead HP2 4AD, UK.

Correspondence should be sent to Mr P. H. P. Dyson; e-mail: dysonphp{at}yahoo.co.uk

There have been very few reports in the literature of gout and pseudogout of the spine. We describe six patients who presented with acute sciatica attributable to spinal stenosis with cyst formation in the facet joints. Cytopathological studies confirmed the diagnosis of crystal arthropathy in each case.

Specific formation of a synovial cyst was identified pre-operatively by MRI in five patients. In the sixth, the diagnosis was made incidentally during decompressive surgery. Surgical decompression alone was undertaken in four patients. In one with an associated degenerative spondylolisthesis, an additional intertransverse fusion was performed. Another patient had previously undergone a spinal fusion adjacent to the involved spinal segment, and spinal stabilisation was undertaken as well as a decompression.

In addition to standard histological examination material was sent for examination under polarised light which revealed deposition of urate or calcium pyrophosphate dihydrate crystals in all cases.

It is not possible to diagnose gout and pseudogout of the spine by standard examination of a fixed specimen. However, examining dry specimens under polarised light suggests that crystal arthropathy is a significant aetiological factor in the development of symptomatic spinal stenosis associated with cyst formation in a facet joint.