Diagnostic challenges of spinal gout: patient series.

backgroundSpinal gout can be seen as a metabolic disorder disease mainly caused by urate deposition. In this report, the authors attempt to find the common characteristics of spinal gout. Subsequently, they explore state-of-the-art techniques for diagnosing spinal gout and potentially elucidating its prevalence. OBSERVATIONS: The authors conducted a retrospective analysis of the medical records of patients diagnosed with spinal tophaceous gout at The First Affiliated Hospital of Guangxi Medical University during a 5-year period from March 2019 through May 2024. Data on serum uric acid levels, C-reactive protein, and other relevant parameters were collected. The cohort included 12 patients (8 males, 4 females; aged 29-78 years). Four had cervical involvement presenting with upper limb numbness and weakness, while the remaining 8 had lumbar lesions mainly causing low back pain. Imaging showed typical features: radiographic imaging revealed "punched-out" lytic lesions, CT imaging demonstrated soft tissue-like density with marginal sclerosis; and MRI showed iso- or hypointense T1 signals and variable T2 patterns based on urate deposition extent. LESSONS: Spinal gout remains challenging to diagnose early. Clinicians should consider it in patients with a history of gout and new-onset back pain. Prompt diagnosis and treatment are crucial once suspected. https://thejns.org/doi/10.3171/CASE25216.