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Gout in the cervical spine: MR pattern mimicking diskovertebral infection

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Thierry Duprez at Université Catholique de Louvain - UCLouvain
Thierry Duprez
Jacques Malghem at Cliniques Universitaires Saint-Luc
Jacques Malghem
Bruno Vande berg at Université Catholique de Louvain - UCLouvain
Bruno Vande berg
H M Noel
H M Noel
H M Noel
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Abstract and Figures

We report the MR features of a surgically proved cervical spine involved with gouty tophi in a patient with a long history of hyperuricemia. Tophi appeared as sharply delineated areas of low signal intensity on T1 and T2 MR images and showed intense and homogeneous signal enhancement on post-contrast images.
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Gout in the Cervical Spine: MR Pattern Mimicking
Diskovertebral Infection
Thierry P. Duprez, Jacques Malghem, Bruno C. Vande Berg, Henri M. Noel, Everard A. Munting, and
Baudouin E. Maldague
Summary: We report the MR features of a surgically proved
cervical spine involved with gouty tophi in a patient with a long
history of hyperuricemia. Tophi appeared as sharply delineated
areas of low signal intensity on T1 and T2 MR images and
showed intense and homogeneous signal enhancement on post-
contrast images.
Index terms: Metabolic disorders; Spine, magnetic resonance
Gout is a common metabolic disorder with
well-defined clinical, biochemical, and radio-
logic features (1, 2). Gouty arthritis typically
affects the distal joints of the appendicular skel-
eton (1–4). Involvement of the axial skeleton is
uncommon, and urate deposition in the spine is
rare (1, 2); however, the prevalence of spinal
gout involvement remains controversial (5).
Histologically proved cases of gouty involve-
ment of the spine have been reported in the
literature (6–25). Most of them presented with
symptomatic cord or root compression
(12–25). Radiologic findings are not specific
and include disk space narrowing and spondy-
lodiscal erosive changes (6, 10). The odontoid
process of C2 may be involved (10), as may the
lumbar posterior joints (9, 11).
Case Report
A 59-year-old man with long-standing gout presented
with progressive impairment of walking. The symptoms
had appeared 1 year previously and finally resulted in a
tetraparetic state. Both clinical examination, revealing bi-
lateral pyramidal signs, and electrophysiological studies
including evoked potentials and electromyography, were
consistent with spinal cord compression.
Retrospective inquiry revealed insufficient compliance
with the hypouricemic treatment (combining allopurinol 300
mg daily and dietary restrictions) and persistent serum levels
of uric acid as high as 590
m
mol/L (normal values, 180 to
360
m
mol/L).
Plain films of the hands and feet (not shown) demon-
strated multifocal joint lesions with features typical of
gouty arthritis. Plain films of the cervical spine (Fig 1A)
demonstrated severe destructive and proliferative dis-
covertebral changes from C3-4 to C5-6. Magnetic reso-
nance (MR) examination at 0.5 T included precontrast and
postcontrast sagittal T1-weighted spin-echo images (450/
20/4 [repetition time/echo time/excitations]) and sagittal
T2-weighted fast spin-echo images (3200/120/6, echo
train 16). Multiple areas of low signal intensity on both T1
and T2 images showed an intense and homogeneous en-
hancement after administration of contrast (Fig 1B–D).
Surgical treatment consisted of corporectomies of C-4
and C-5 followed by bilateral foraminotomies of C3-4,
C4-5, and C5-6. Interposition of an autogeneous bone
graft (fibula) between C-3 and C-6 completed the proce-
dure. During surgery, disk spaces C4-5 and C5-6 were
indistinguishable from the adjacent vertebral bodies, and
the resected posterior longitudinal ligament was thickened
with patchy white deposits consistent with gouty tophi.
Pathologic examination of the specimens demonstrated
amorphous urate deposits and reactive bone fragments
embedded within a chronic inflammatory stroma (Fig 1E).
However, variable degrees of fibrous change were ob-
served in the reactive stroma, and numerous vascular
channels were seen at all places. No features of tumoral or
infectious process were seen. Bacteriologic examinations
of multiple specimens were negative. These included the
special procedures for detecting mycobacteria. A mild
clinical improvement with partial neurologic recovery
occurred after surgery.
Discussion
Involvement of the spine in patients with gout
has been reported (1, 2). The proved cases un-
derwent either biopsy to rule out other processes
(6–11) or decompressive surgery in the presence
of root or cord compression (12–25). Considering
these 14 reports on this topic and including our
case, neurologic compression may occur in all
segments of the spine: 6 cases in the cervical
Received October 31, 1994; accepted after revision April 7, 1995.
From the Departments of Diagnostic Imaging (T.P.D., J.M., B.C.V.B., B.E.M.), Pathology (H.M.N.), and Orthopaedics (E.A.M.), Cliniques Universitaires
Saint Luc, Universite Catholique de Louvain, Brussels, Belgium.
Address reprint requests to Thierry P. Duprez, Department of Radiology, Cliniques Universitaires Saint Luc, Av Hippocrate 10, 1200-Brussels, Belgium.
AJNR 17:151–153, Jan 1996 0195-6108/96/1701–0151
q American Society of Neuroradiology
151
Fig 1. A, Lateral-view radiograph of the cervical spine shows atypical diskovertebral changes from C-3 to C-6. Deep erosions of
several end plates (black arrow) are associated with hyperostosis (star) and prominent marginal osteophytosis (white arrows).
B, Unenhanced sagittal T1-weighted spin-echo MR image (450/20) shows large hypointense areas within the vertebral bodies of C-4,
C-5, and C-6 without changes in the adjacent epidural and prevertebral spaces.
C, Postcontrast T1-weighted MR image in the same plane. Enhanced foci involve both the C-4 to C-6 disk spaces and the contiguous
vertebral erosions. The ventral segment of C5-6 is spared despite dorsal involvement. Note the continuum between the diskal and
vertebral lesions.
D, T2-weighted fast spin-echo MR image (3200/120, echo train length 16) in the same plane. The enhanced foci in C appear as
low-signal-intensity areas. Cord compression is obvious at the C5-6 level.
E, Histologic section of a surgically resected specimen. Two tophaceous deposits (thick black arrows) surrounded by histiocytes and
multinucleated giant cells (open arrows) are embedded in a chronic inflammatory stroma. Vascular channels (stars) and cancellous bone
fragments (curved arrow) without lamellar organization are present. Note pseudopalissadic disposition of histiocytes surrounding tophi
(small double arrowhead).
152 DUPREZ AJNR: 17, January 1996
segment (16, 18, 20–22), 4 cases in the thoracic
segment (12, 15, 17, 25), and 5 cases in the
lumbar spine (13, 14, 19, 23, 24).
Bone erosions by the urate crystal deposits and
secondary proliferative bone changes are the
prominent but nonspecific feature of spinal gout
on plain films. Computed tomography may help
in delineating bone and soft-tissue changes and in
disclosing tophi as low-density areas.
In the case reported here, deep erosions of mul-
tiple end plates (Fig 1A and B) and tissue en-
hancement both within the disks and adjacent
vertebral bodies (Fig 1C) initially suggested the
diagnosis of diskovertebral infection. However,
some MR features of the lesions were different
from the usual presentation of a diskovertebral
infection. These lesions were sharply delineated
without surrounding infiltrative changes; normal
disk tissue persisted immediately adjacent to the
destroyed diskal areas, and no significant bone
marrow edema was seen in the trabecular bone
adjacent to the lesions. On T2-weighted images,
the diskal and intravertebral lesions disclosed an
unexpected low signal intensity, and the adjacent
soft tissues were normal.
The MR signal and vascularization character-
istics of the gouty tophi observed in this case
(ie, low signal intensity both on T1 and T2 im-
ages and homogeneous enhancement on post-
contrast images) are remarkable. They possibly
reflect the dual histologic component of the le-
sions (Fig 1E). The low signal intensity seen on
T2-weighted images may result from the pres-
ence of fibrous tissue and crystalline structures.
We similarly observed hypointense gouty tophi
on T2-weighted images in peripheral joints in
other patients. In turn, the enhancement seen
on postcontrast images may reflect the pres-
ence of vascularized reactive tissue within
lesions.
The segmental pattern of disk involvement
observed in our patient is unusual in diskover-
tebral infection, which generally involves the
entire disk surface. A few cases of pyogenic
infection have shown a subtle and limited con-
trast enhancement of the disk (26). In addition,
infectious vertebral erosions are usually not as
sharply marginated as in this case.
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AJNR: 17, January 1996 GOUT IN THE SPINE 153
... Therefore, the main imaging differentiation factors between these conditions should be further investigated. Up to now, there have only been 10 cervical gout cases with images reported in the English-language literature searched in PubMed [3][4][5][6][7][8][9][10][11]; most of them showed the incomplete image sequence and poor image quality which were insufficient to understand the imaging manifestations of this condition for improving diagnostic accuracy. In this article, we report a case about a spinal gout affected the cervical disc and adjacent endplates with a complete and continuous image data with higher image quality and resolution than previous published cases, whose etiology was initially not completely determined and suspected as infectious spondylodiscitis, and provide a brief literature review concerning cervical gout. ...
... In our case, gout-related cervical spine lesions were confirmed and a series of complete and continuous highresolution images including multiplanar reconstruction (MPR), volume rendering (VR) CT images, plain and contrast-enhanced MR images together with exhaustive description were fully displayed. To the best of our knowledge, there have only been 10 such cases with images reported in the English-language literature searched in PubMed (Table 1) [3][4][5][6][7][8][9][10][11]; most of them just show incomplete and indistinct images. Due to that there were also reports that spinal gout had similar image appearance to infection [4,5,16,17], the main imaging differentiation factors between these conditions should be further discussed. ...
... To the best of our knowledge, there have only been 10 such cases with images reported in the English-language literature searched in PubMed (Table 1) [3][4][5][6][7][8][9][10][11]; most of them just show incomplete and indistinct images. Due to that there were also reports that spinal gout had similar image appearance to infection [4,5,16,17], the main imaging differentiation factors between these conditions should be further discussed. Gouty involvement in intervertebral disc may be rarer than facet joint, which mostly mimics pyogenic discitis [5,11,16,18], but it showed the opposite outcome in the reports reviewed in our article. ...
Gout involved the cervical disc and adjacent vertebral endplates misdiagnosed infectious spondylodiscitis on imaging: case report and literature review
Article
Full-text available
  • Sep 2019
  • BMC MUSCULOSKEL DIS
Background: Gout in spine is rare and commonly mimics some infectious or tumoral lesions, the differentiation of spinal gout from other diseases is not always easy. We report a case of gout involved cervical disc and adjacent vertebral endplates whose etiology was initially not determined. Compared with the previous published 10 similar cases, this case displayed a complete and continuous image data with higher image quality and resolution than before. So we give a brief literature review for concerning cervical gout, with the emphasis on the discussion of radiological findings. Case presentation: A 50-year-old male with a 5-year history of neck and shoulder pain had muscle atrophy and weakness in both arms. Physical examination revealed multiple tophi were seen in left wrist, both feet and knee; bilateral superficial sensory declined below level of mastoid portion and the muscle strengths of limbs decreased. Laboratory findings showed hyperuricemia and the C-reactive protein level was very high. Imaging studies including Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) showed abnormality of the C5-6 intervertebral disc and irregular osteolytic destruction of both adjacent C5-6 endplates, narrowing of C5-6 disc space and swelling of prevertebral soft tissue. Under the circumstance of the lesions being not determined and nerve root symptoms, surgical treatment was performed and pathological examination of the specimen revealed deposited uric acid crystals surrounded by granulomatous inflammation. After surgery combined with pharmaceutical and rehabilitation treatment, the muscle strengths of limbs, the pain of neck and shoulder and the level of serum uric acid were all improved. Conclusions: Cervical spinal gout involving the disc and adjacent vertebral endplates is uncommon and may misunderstand infectious spondylodiscitis. Physician and radiologist should take the gouty spondylitis into account with a combination with previous history and clinical manifestations when encountering with such this condition.
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... Medication such as colchicine is the primary treatment for patients with gouty arthritis involving large joints in the upper extremities to reduce uric acid concentrations combined with the dietary intervention [17]. However, some patients may be admitted to the hospital with no obvious symptoms and only with swelling around the joint, which requires imaging combined with laboratory tests to arrive at an accurate diagnosis and provide targeted interventions to prevent possible future symptoms [18][19][20][21][22][23]. In addition, surgery such as arthrotomy and aspiration, lesion removal, and joint replacement may be planned according to the patient's condition to prevent more serious bone destruction of the joints caused by tophi deposition [17]. ...
Computed tomography and magnetic resonance imaging findings in gouty arthritis involving large joints of the upper extremities
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Full-text available
  • Sep 2022
  • BMC Med Imag
Background We aimed to analyze the computed tomography (CT) and magnetic resonance imaging (MRI) findings of gouty arthritis primarily involving the large joints of the upper limbs, signal or density characteristics of the tophi, growth patterns, involvement of the adjacent joints, and differentiation from other lesions occurring in this area and to discuss the causes of misdiagnosis. Methods CT and MRI data were collected from 14 patients with gouty arthritis, primarily involving the shoulder and elbow joints, and their imaging features were analyzed. Results All the patiens were ranged from 28-85 years old, and the tophi deposition can be observed on either CT or MRI.The tophi deposition apperas as slightly higher density nodules or masses on CT images,or nodules or masses on MRI with isosignal/hypointensity on T1WI and hyperintensity on T2WI. Five patients showed narrowing of the affected joint space, four had different degrees of bone erosion under the articular surface, eight developed joint effusion, and all showed surrounding soft tissue swelling. The tophi grew around the joint, with anterolateral and posterolateral tophi predominantly in the shoulder joint and dorsal tophi predominantly in the elbow joint on the MRI, with compression and edema of the surrounding soft tissues. Conclusions Gouty arthritis occurs in the large joints of the upper limbs and is characterized by fluid accumulation in the joint capsule and the formation of tophi. These tophi are usually large, with subcutaneous bone resorption and erosion, with or without cartilage destruction. However, extensive edema appeared in the soft tissue around the tophi, but the edema only produced pressure without any obvious signs of soft tissue infiltration, which may be distinguished from the joint tumor. In addition, the gout incidence rate is increased in young patients. Therefore, when the patient has a large joint mass, it is important to confirm whether there is a history of gout.
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... However, there are also some patients without nerve compression or low back pain. These patients need combined imaging and laboratory examination to make the correct diagnosis and treatment to avoid future symptoms [22][23][24][25][26][27][28]. ...
CT image findings of spinal gout
Article
  • Feb 2022
  • SPINAL CORD
Background: Spinal gout is uncommon. The clinical manifestations of spinal gout are not characteristic. Huge tophi can invade the vertebral joints and protrude into the spinal canal, even causing spinal canal stenosis, which may result in irreparable spinal cord injury. Therefore, early diagnosis and treatment is very important. Summarizing the imaging features of spinal gout may help clinicians with an early diagnosis and promptly intervention. Study design: Retrospective case series. Objectives: To describe the findings from computed tomography (CT) images of spinal gout, including the tophi location, growth pattern, involvement of adjacent joints, and differentiation from other spinal lesions. Methods: We analyzed CT images from the atlantoaxial joint and lumbar spine in 17 cases with spinal gout. Results: 17 cases had tophi as high-density masses. 14 (82.4%) cases involved lumbar facet joints, including 7(41.2%)cases involving single vertebral facet joints and 7(41.2%) cases involving multiple vertebral facets. CT imaging showed bone resorption and erosion of the facet joints, as well as narrowing of the joint space. The other three cases (17.6%) involved the atlantoaxial joint, showing a high-density mass around the odontoid process with bone resorption and invasion under the articular surface. One case was secondary to a pathological fracture. Four cases (23.6%) showed a huge mass protruding into the spinal canal where the nerve root was compressed, and even spinal cord injury, leading to serious lower back pain symptomatic of brachial plexus or sciatic nerve compression, and even affected the motor function of lower limbs. Conclusions: In cases with gouty arthritis involving the axial spine, the lower lumbar spine is mainly involved, high-density tophi grow forward and backward around the facet joints, CT image shows bone resorption, erosion of facet joints, and narrowing of the joint space. With atlantoaxial joint involvement, there was evidence of bone resorption combined with joint.
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... The diagnosis of spinal tophi was not suspected despite our patient having multiple peripheral tophi and having acute polyarticular gout at the time of presentation. Similar case reports have been published in which initial suspected epidural abscess and spondylodiscitis were later found to be spinal tophi after surgery was performed [3][4][5][6][7][8]. ...
A rare cause of back pain and radiculopathy - Spinal tophi: A case report
Article
Full-text available
  • Jan 2019
  • J Med Case Rep
Background Gout is a monosodium urate deposition disease which is prevalent worldwide. The usual manifestations are crystal arthropathy and tophi deposition in the soft tissues. Spinal tophi may also occur and are rarely reported, resulting in various clinical manifestations such as back pain, spinal cord compression, radiculopathy, and even mimicking epidural abscess and spondylodiscitis. Case presentation We report a case of a 42-year-old Chinese man with underlying gout who presented with back pain and radiculopathy. The diagnosis of spinal tophi was unsuspected and he was initially treated for epidural abscess and spondylodiscitis. He underwent a laminectomy and posterolateral fusion during which tophus material was discovered. He recovered and medications for gout were started. Conclusion Spinal tophi are rare. The diagnosis is difficult and spinal tophi may be mistaken for epidural abscess, spondylodiscitis, or neoplasm.
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CT and MRI findings in gouty arthritis involving large joints of the upper extremities
Preprint
Full-text available
  • Mar 2022
Background Gouty arthritis is a type of metabolic disease in which sodium urate crystals are deposited in the bone and joints, causing local inflammatory reactions and destruction of the bone tissue. Gouty arthritis involving the large joints of the upper extremities is rare in clinical practice. This study aimed to analyze the computed tomography (CT) and magnetic resonance imaging (MRI) findings of gouty arthritis primarily involving the large joints of the upper limbs, signal or density characteristics of the tophi, growth patterns, involvement of the adjacent joints, and differentiation from other lesions occurring in this area and to discuss the causes of misdiagnosis. Methods CT and MRI data were collected from 14 patients with gouty arthritis, primarily involving the shoulder and elbow joints, and their imaging features were analyzed. Results 14 patients were aged between 28 and 85 years,All patients demonstrated nodular or mass-like abnormal signal shadows on CT, with equal or slightly long signals on T1-weighted image (WI) and short or slightly long signals on T2WI in the MRI. All 14 patients revealed narrowing of the affected joint space, with bone resorption and erosion under the joint surface of the larger tophis. The tophis grew around the joint, with anterolateral and posterolateral tophis observed predominantly in the shoulder joint, and dorsal tophis observed predominantly in the elbow joint on the MRI, with compression and edema of the surrounding soft tissues. Conclusions We analyzed patients with gouty arthritis involving the large joints of the upper extremities and observed an increased prevalence in young and middle-aged men who may have had clear tophi in the past.
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CT and MRI findings in gouty arthritis involving large joints of the upper extremities
Preprint
Full-text available
  • Mar 2022
Background Gouty arthritis is a type of metabolic disease in which sodium urate crystals are deposited in the bone and joints, causing local inflammatory reactions and destruction of the bone tissue. Gouty arthritis involving the large joints of the upper extremities is rare in clinical practice. This study aimed to analyze the computed tomography (CT) and magnetic resonance imaging (MRI) findings of gouty arthritis primarily involving the large joints of the upper limbs, signal or density characteristics of the tophi, growth patterns, involvement of the adjacent joints, and differentiation from other lesions occurring in this area and to discuss the causes of misdiagnosis. Methods CT and MRI data were collected from 14 patients with gouty arthritis, primarily involving the shoulder and elbow joints, and their imaging features were analyzed. Results 14 patients were aged between 28 and 85 years,All patients demonstrated nodular or mass-like abnormal signal shadows on CT, with equal or slightly long signals on T1-weighted image (WI) and short or slightly long signals on T2WI in the MRI. All 14 patients revealed narrowing of the affected joint space, with bone resorption and erosion under the joint surface of the larger tophis. The tophis grew around the joint, with anterolateral and posterolateral tophis observed predominantly in the shoulder joint, and dorsal tophis observed predominantly in the elbow joint on the MRI, with compression and edema of the surrounding soft tissues. Conclusions We analyzed patients with gouty arthritis involving the large joints of the upper extremities and observed an increased prevalence in young and middle-aged men who may have had clear tophi in the past.
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The authors present a case report of a patient discovered to have a rotatory subluxation of the C1–2 joint and a large retroodontoid pannus with an enhancing lesion in the odontoid process eventually proving to be caused by gout. This patient represented a diagnostic conundrum as she had known prior diagnoses of not only gout but also sarcoidosis and possible rheumatoid arthritis, and was in the demographic range where concern for an oncological process cannot fully be ruled out. Because she presented with signs and symptoms of atlantoaxial instability, she required posterior stabilization to reduce the rotatory subluxation and to stabilize the C1–2 instability. However, despite the presence of a large retroodontoid pannus, she had no evidence of spinal cord compression on physical examination or imaging and did not require an anterior procedure to decompress the pannus. To confirm the diagnosis but avoid additional procedures and morbidity, the authors proceeded with the fusion as well as a posterior biopsy to the retroodontoid pannus and confirmed a diagnosis of gout.
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Crystal-associated arthropathies
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  • May 1989
A wide variety of crystals have been described in association with articular disease, and previous investigations have shown a well-defined role for crystals in the pathogenesis of self-limited attacks of acute arthritis. Crystals have also been linked to chronic joint disease, but the relationship between the two is controversial. Diagnostic imaging is important in the assessment of arthropathies, particularly because it provides information about gross pathologic changes that cannot be readily determined by other methods, especially in early disease. Therefore, clinical studies correlating diagnostic imaging with laboratory and histologic findings may ultimately help to elucidate the true relationship between crystals and chronic joint disease.
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Paraparesis Secondary to Sodium Urate Deposits in the Ligamentum Flavum
Article
  • Dec 1976
  • ARCH NEUROL-CHICAGO
Compression of the spinal cord or roots by sodium urate deposits has been demonstrated previously only twice.1.2 In three other autopsy cases, sodium urate was deposited in tissues surrounding the spinal cord and cauda equina, including vertebral bodies and disks,3 intervertebral facets,4 and odontoid, atlas, and dura.5 Report of a Case.— We examined a 74-year-old man who had gout and hyperuricemia since 1964 (serum levels have varied from 7.1 to 10.6 mg/dl). For the two years preceding hospital admission, allopurinol, 400 mg/day, and colchicine, 1.0 mg/ day, were prescribed, but probably not taken regularly. The patient noted severe, unrelenting pain radiating into both buttocks in February 1975. The pain was aggravated by sitting on a toilet seat, but not by Valsalva maneuvers. The pain gradually increased in intensity, and paresis of dorsi and plantar flexion of both feet developed in May 1975.
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Sudden hypotonic paraparesis caused by tophaceous gout of the lumbar spine
Article
  • Feb 1991
  • CLIN NEUROL NEUROSUR
Gouty arthritis of the axial skeleton is rare, and neurological complications due to spinal cord or nerve root compression secondary to tophaceous deposits have been seldom reported. We describe a patient with chronic gouty arthritis who developed an acute paraparesis caused by tophaceous cauda equina compression. Surgical removal of the mass resulted in complete recovery.
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Gadolinium-Enhanced MR in Spinal Infection
Article
  • Sep 1990
The purpose of this study was to determine what advantages the use of paramagnetic contrast material might have in evaluating patients clinically suspected of having spinal infection. To determine this we prospectively examined with noncontrast and contrast magnetic resonance (MR) 33 such patients and correlated the MR diagnoses with clinical and pathologic data. Our results showed the following advantages of gadolinium-enhanced MR: it (a) provided excellent anatomical delineation of all epidural abscesses, routinely differentiating them from the adjacent compressed thecal sac even when this was not possible by noncontrast MR; (b) increased observer confidence in the diagnosis of disk space infection and osteomyelitis in patients with equivocal noncontrast MR; (c) localized those portions of paraspinal masses most likely to yield a positive percutaneous biopsy; and (d) identified active infections from those that had responded adequately to antibiotic therapy. We conclude that contrast MR is a valuable adjunct to noncontrast MR when diagnosis, anatomical clarity, and/or lesion activity requires further elucidation.
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[Paraparesis due to gout]
Article
  • Jan 1990
A case of a 23 year-old-man with a history of polyarthritis and chronic tophaceous gout is reported. He developed a crural paraparesis caused by sodium urate deposits in the spinal canal. Decompressive laminectomy and removal of urate-laden ligamentum flavum was performed without improvement. According to the literature there are nine cases previously reported.
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Four unusual cases of Spinal Cord Compression
Article
  • Jun 1987
Four cases of spinal cord compression are presented, the causes being tuberculoma, haemangioma, gouty tophus and exophytic glioma; the first three being extradural, extraosseous in location. A short discussion follows. These cases are presented to remind the reader to keep less common causes in mind when dealing with a case of spinal cord compression.
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