Spinal neuroarthropathy associated with Guillain-Barré syndrome

Abstract

Since the rarefaction of neurosyphilis, axial neuroarthropathy is mostly secondary to spinal cord pathologies. Peripheral manifestations of neuroarthropathy resulting from Guillain-Barré syndrome have already been reported but to our knowledge, this is the first case of a patient diagnosed with axial involvement. After the acute phase, a 47-year-old woman suffered of paraparesia with a partial loss of sensibility under the tenth thoracic vertebra. As a consequence, she developed first of all neuroarthropathy of both knees and few years later, a spinal involvement was discovered. Multiple surgeries of both knees and of the spine were required, due to non-union, relapse, and infection. Natural evolution of Charcot spine remains unknown. Surgical treatment is recommended but even with circumferential fusion, failures do frequently occur. This observation allows us to report an original case and to discuss the etiology of axial neuroarthropathy, the classical radiographic findings, and the inherent difficulties of its treatment.

Fig. 1

X-ray of the right knee showing peripheral neuroarthropathy initiating the Charcot disease

Fig. 2

Lumbar spine roentgenograms showing axial neuroarthropathy (L2L3, L4L5) before surgey (a, b) and after first posterior surgery with lumosacral iterative circumferential fusion (c, d)

Fig. 3

Extension of the posterior arthrodesis up to the T3 vertebra for T9–T10 relapse of spinal neuroarthropathy with vertebral numbering

Fig. 4

MRI T2-weighted sagittal image showing a T3 fracture associated with spinal cord compression

Fig. 5

Full spine roentgenograms with posterior instrumentation and fusion from T3 to iliac wings, at last follow-up