Case ReportPosttraumatic Charcot (Neuropathic) Spinal Arthropathy at the Cervicothoracic Junction
Introduction
Charcot spinal arthropathy (CSA) of the spine is associated with complete spinal cord injuries, especially at the thoracolumbar region. It often occurs at sites distal to previous instrumentation but rarely in proximal regions, more so in the cervicothoracic region, where it rarely has been reported to occur in traumatic spine cases. It causes severe pain and instability in these patients, and repeated surgical instrumentations and revisions are necessary for stability to facilitate mobilization in these patients. The choice of treatment and approach is still a matter of debate in the literature.
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Case Report
A 56-year-old man presented with discomfort and back pain that had been worsening for 3 years. He currently had difficulty breathing because of instability of the spine, especially when he was seated. He also heard crackling sounds on movement, which made him anxious. He had complete paraplegia for 21 years secondary to a gunshot injury to the spinal cord. A biopsy of his spine lesion was performed at a peripheral hospital 2 months previously, which was negative for infection or tumor processes.
Discussion
Charcot arthropathy was named after Jean Martin Charcot in 1868, when he described a case of tabetic arthropathy secondary to syphilis. The first case of Charcot of the spine (neuropathic spinal arthropathy) was described by Kronig, a German physician, in 1884,1, 2 secondary to syphilis. The first case of “Charcot spine” secondary to trauma was reported in 1978 by Slabaugh and Smith.3 There are several publications in which CSAs are described attributable to tertiary syphilis, diabetes,
Conclusions
CSA is a rare complication of spinal cord injury and a challenge to the spine surgeons. The unstable forms are quite debilitating, and surgical stabilization with fusion and instrumentation is necessary. New CSA can occur below the instrumented level but rarely also occurs above the level of injury or instrumentation. The spine surgeon should be aware of this risk and consideration placed during surgical approach. It is necessary to strive to achieve, where possible, 3-column stability fusion
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Cited by (3)
Cerebrospinal fluid-cutaneous fistula associated with post-traumatic Charcot spinal arthropathy: A case report and review of literature
2020, BMC Musculoskeletal DisordersCharcot spinal arthropathy
2018, Journal of Craniovertebral Junction and Spine
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.