Postoperative tophus in the thoracic spine: a case report and literature review

Background: Among all cases of spinal tophaceous gout, thoracic involvement is the least frequently reported. Here, we present a rare case of tophus formation at adjacent segments following thoracic spinal internal fixation surgery, which resulted in severe neurological symptoms. To our knowledge, no such case has been previously reported in the literature. Based on this rare presentation, we propose new insights into the preferential deposition sites of thoracic spinal tophi and provide a comprehensive review of previously reported cases. Case presentation: A 49-year-old Chinese male with an 11-year history of gout and hyperuricemia presented with a 10-month history of bilateral lower limb weakness and numbness. Anterior decompression and bone grafting with titanium plate fixation at T5–T9 were performed 16 years ago for a traumatic thoracic vertebral fracture. Imaging on admission revealed calcified space-occupying lesions located in the epidural space at T4–T5, T9–T10, and T11–T12, primarily involving segments adjacent to the surgical site. The patient underwent thoracic laminectomy with internal fixation. Postoperatively, the weakness in the lower extremities was partially improved; however, the numbness persisted. Conclusion: This case of tophus formation in segments adjacent to a previous thoracic spine surgery may be associated with segmental degeneration and increased mobility caused by postoperative biomechanical changes.