{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T05:50:12Z","timestamp":1791352212304,"version":"4.3.1"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intraspinal tophaceous gout, defined as monosodium urate crystal deposition within the effective spinal canal causing neural compression, is a rare subtype of spinal gout with no unified diagnostic standard. Despite documented gout history, it is frequently misdiagnosed preoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed five male patients with pathologically confirmed intraspinal tophaceous gout (median age 25 years, range 21\u201348) admitted to two tertiary hospitals between January 2018 and May 2026, alongside a systematic literature review of strictly defined cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The preoperative misdiagnosis rate was 60%. Computed tomography values of 142\u2013272 Hounsfield units provided diagnostic clues, yet no patient underwent preoperative dual-energy computed tomography. Three patients underwent open decompression with fusion, one endoscopic decompression, and one computed tomography-guided biopsy followed by conservative observation; pathology confirmed gouty tophus or granuloma in all. One patient developed a postoperative intraspinal hematoma on day 4, a previously unreported complication. Long-term follow-up revealed multiple vertebral compression fractures and thoracic spinal cord injury in one patient with poor compliance with urate-lowering therapy, a bone event that requires long-term vigilance. Pooled analysis of the 38 strictly defined cases (33 literature cases plus this series) confirmed that the preoperative misdiagnosis rate exceeds 50% and that most lesions are epidural.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Intraspinal tophaceous gout should be considered in young male patients with back pain and neural deficits, even with known gout history. A stepwise imaging strategy, individualized surgical or biopsy-first management, vigilant postoperative monitoring, and long-term urate-lowering therapy are essential for optimal outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1961092","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:53:48Z","timestamp":1791348828000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Clinical characteristics and management strategies of intraspinal tophaceous gout: a case series and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Hongyan","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Pathology, Shengli Oilfield Central Hospital","place":["Dongying, Shandong, 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