Charcot spinal arthropathy: an increasing long-term sequel after spinal cord injury with no straightforward management

Abstract

Charcot spinal arthropathy (CSA) is most likely increasing in patients suffering from consequences of spinal cord injury. We want to highlight initial symptoms, certain risk factors and perioperative complications of this condition. A single center retrospective case series in a specialized Center for Spinal Cord Injuries, BG Trauma Center Murnau, Germany highlighting the potential obstacles in the management of Charcot spine. We describe four female paraplegic patients (mean age: 50.75 years; range: 42-67), who developed Charcot spinal arthropathies. The mean age at the time of the accident was 21.5 years (3-35), the time lag after the accident before CSA was developed and finally diagnosed was on average 29.5 years (17-39) and the mean follow-up period was 39.5 months (6-73). Patient histories, initial symptoms, risk factors as well as the management and postoperative complications are provided. Charcot spine is an important potential sequel of spinal cord injury, which can lead to significant disability and spinal emergencies in affected individuals. More studies are needed to provide better recommendations for spine surgeons. Conservative treatment is an option. Posterior fixation alone does not seem to be sufficient.

Keywords: Central nervous system; Spinal cord diseases.

Figure 1

Patient 1. (a) Sagittal T2-weighted MR image of the lumbar spine 4 years later to a; (b) lateral X-ray showing dorsal spondylodesis; (c) Anterior-posterior X-ray showing implant loosening 1 year after (d); (d) Sagittal CT indicating Charcot spine lesions in adjacent segments; (e) Sagittal CT 7 months after (d).

Figure 2

Patient 2. (a) Sagittal T2-weighted MR image showing a lumbosacral substance defect; (b) Lateral X-ray 3 years before (a); (c) According sagittal CT image to a; (d) Sagittal CT 4 years after (a) showing shortening of Harrington rod and adjacent CSA above the instrumentation.

Figure 3

Patient 3. (a) X-ray taken during an urodynamic control examination showing signs of ankylosing spondylitis 4 years before (b). (b) X-ray with a CSA lesion at the level of L4/5. (c) According coronar CT to b. (d) X-ray after a 6-year follow-up period showing radiologic progression with a clear pseudotumoral appearance.

Figure 4

Patient 4. (a) Coronar T2-weighted MR image showing a fluid-filled disc space at the level of L3/4 with significant bone destruction and paravertebral abscess formation; (b) lateral X-ray highlighting implant loosening; (c) lateral X-ray showing similar erosion to prior examinations.