A 92-year old woman was admitted to the geriatric department because of a confusional state due to a urinary tract infection, a severe dermatitis and gout. An incomplete tetraplegia was found on physical examination. Radiological examination showed a large gouty tophus causing spinal cord compression and destruction of the dens. Gouty involvement of the spine is a less common complication of the disease. Optimal treatment of gout is important to prevent the development of such severe complications.