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attending hospital due to low back pain&#46; One year earlier he experienced onset of progressive low back pain irradiating to the left pelvic limb&#46; Six months earlier he presented sudden onset left knee arthritis&#44; which remitted with anti-inflammatory drugs&#46; The patient was hospitalised&#44; physical examination found independent gait&#44; guarding&#44; claudication&#44; decreased spinal mobility due to pain&#44; positive Las&#232;gue and Bragard&#44; hypoaesthesia in L5-S1 dermatome&#44; and RI with joint effusion&#46; Blood biometry&#44; urinalysis&#44; erythrocyte sedimentation rate and C-reactive protein with normal parameters&#44; serum uric acid of 11&#46;8<span class="elsevierStyleHsp" style=""></span>mg&#47;dl and uric acid in 24<span class="elsevierStyleHsp" style=""></span>h urine test&#58; 560<span class="elsevierStyleHsp" style=""></span>mg&#46; X-ray with lytic spondylolisthesis of L5&#44; on magnetic resonance imaging &#40;MRI&#41; hypointense signal in T1 and heterogeneous in T2 located in the L4-L5 interspinous space&#44; and in the left facet joint invading the neuroforamen with bilateral lysis of the interarticular pars &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Ultrasound of the left knee showed &#8220;double contour&#8221; of the cartilage of the medial femoral condyle &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41; and thick-walled Baker&#39;s cyst with hyperechoic stippling in its interior &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; Laminectomy&#44; L5 radicular release&#44; L5-S1 transpedicular fixation and postero-lateral arthrodesis&#46; The histopathological study of the material removed by surgery reported amorphous amphophilic acellular material comprising epithelioid histiocytes fusing their cytoplasms together to form foreign body multinucleated giant cells &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Tophaceous gout in the lumbar spine is rare&#46; All the segments of the spine can be affected by gout&#44; however most gouty tophi are located in the lumbar spine&#44; especially in the L4-L5 region&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Tophus is a chronic manifestation of gout&#44; its presence indicates that the patient has had at least one disease of 5 years of evolution with no medical treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> The physiopathological mechanism of spinal gout has been associated with poor vascularity&#44; providing an optimal microenvironment for tophus formation&#46; This condition can be the consequence of several factors such as a hyperlipidaemic state&#44; obesity or low physical activity&#44; since the small vessels of the axial skeleton do not have the capacity to adequately filter the uric acid load deposited in this area&#59; likewise the presence of degenerative disc disease also creates a favourable microenvironment for deposit of crystals and tophus formation&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">3&#44;4</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0025" class="elsevierStylePara elsevierViewall">The patient was diagnosed with low back pain and lytic spondylolisthesis&#44; however&#44; the histopathological result of the tissue studied showed findings consistent with gouty tophus in the lumbar spine&#46; The definitive diagnosis of tophaceous gout relies on demonstrating MSU obtained by guided biopsy or surgery&#46; In this clinical case due to the processing of the surgical material&#44; the crystals were not visible&#46; However&#44; the histopathological finding of amorphous material with multinucleated giant cells reacting to a foreign body is consistent with gouty tophus&#46; Surgical treatment is diagnostic and therapeutic and should be considered in patients with neurological impairment&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Presentation of this clinical case ensures a possible diagnosis of spinal tophaceous gout is considered in a patient diagnosed with gout&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Conflict of interests</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Tophaceous deposits in lumbar spine are considered a rare condition&#46; We report the case of a 44-year-old patient with low back pain and radiculopathy&#46; Radiographs revealed lytic spondylolisthesis in L5&#46; Magnetic resonance imaging showed hypointense signal on T1 and a heterogeneous signal on T2 located in the L4-L5 interspinous space and in the left facet joint that invades left neuroforamen&#46; The left knee ultrasound showed &#8220;double contour&#8221; of the medial femoral condyle&#46; Decompressive laminectomy with arthrodesis at the level of L5-S1 was performed&#46; The histological examination revealed amorphous material with a foreign body giant cell reaction&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los dep&#243;sitos de tofos en columna lumbar son una condici&#243;n rara&#46; Presentamos el caso de un var&#243;n de 44 a&#241;os con dolor lumbar y radiculopat&#237;a&#46; Las radiograf&#237;as mostraron espondilolistesis l&#237;tica de L5&#44; la resonancia magn&#233;tica &#40;RM&#41; imagen hipointensa en T1 y heterog&#233;nea en T2 localizado en el espacio interespinoso L4-L5 y en articulaci&#243;n facetaria izquierda que invade el neuroforamen izquierdo&#46; El ultrasonido de rodilla izquierda &#40;RI&#41; evidenci&#243; &#171;doble contorno&#187; del c&#243;ndilo femoral medial&#46; Se realiz&#243; laminectom&#237;a descompresiva y artrodesis de L5-S1&#44; el estudio histopatol&#243;gico report&#243; material amorfo con reacci&#243;n de c&#233;lulas gigantes multinucleadas de tipo a cuerpo extra&#241;o&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Duarte-Salazar C&#44; Mar&#237;n-Arriaga N&#44; Ventura-R&#237;os L&#44; Alp&#237;zar-Aguirre A&#44; Pichardo-Bahena R&#44; Arellano Hern&#225;ndez A&#46; Gota tof&#225;cea en la columna lumbar causando radiculopat&#237;a&#46; Reumatol Clin&#46; 2020&#59;16&#58;410&#8211;412&#46;</p>"
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