Elsevier

World Neurosurgery

Volume 94, October 2016, Pages 580.e1-580.e4
World Neurosurgery

Case Report
Posttraumatic Charcot (Neuropathic) Spinal Arthropathy at the Cervicothoracic Junction

https://doi.org/10.1016/j.wneu.2016.07.064Get rights and content

Background

Charcot spine arthropathy (posttraumatic neuroarthropathy of the spine) has been reported to be a very late and rare complication of spinal cord injury. Charcot of the cervicothoracic and upper thoracic region rarely is reported in the literature. Charcot spinal arthropathy is a cause of progressive deformity and may present as late as 30 years after the original spinal cord injury. This is more common in paraplegic patients who are actively ambulating.

Case Description

A 56-year-old patient with complete paraplegia for approximately 20 years after spinal cord injury presented with severe kyphous deformity and instability of thoracolumbar spine. His sensory level to deep pain was at thoracic (D4). He kept developing new neuroarthropathies at different segments within a span of 5−6 months after every decompression and fusion with anterior cage and posterior instrumentation done. A total of 3 surgeries had been done in span of 2 years, initially thoracic, then lumbar and finally cervicothoracic junction.

Conclusions

We present this case because of the challenges in surgery for instrumentation of new Charcot spinal arthropathy. Reports of neuroarthropathy developing above the level of spinal cord injury and at the cervicothoracic junction are rare. The treating surgeon should be cognizant of the possibility of developing secondary levels of neuroarthropathy above and below a previously successful fusion.

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.

Section snippets

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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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.

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