title: Charcot arthropathy because of congenital insensitivity to pain in an adult.
abstract: BACKGROUND
  Congenital insensitivity to pain is a rare disorder that can lead to neuropathic arthropathy of any joint including the spine. Most of the case reports in the literature are in the pediatric population.
  
  
  OBJECTIVE
  This case report emphasizes the importance of anterior and posterior fusion in patients with congenital insensitivity to pain. The patient was initially treated as if the deformity was postinfectious. STUDY DESIGN SETTING: The patient was treated in a university-based tertiary care center.
  
  
  METHODS
  The patient underwent an anterior decompression and fusion with instrumentation that failed with ambulation. An anterior and posterior revision with instrumentation was then performed to stabilize the Charcot spine.
  
  
  RESULTS
  The patient had an excellent final outcome. At 2 years postoperatively, he is solidly fused and back to his normal occupation.
  
  
  CONCLUSIONS
  Anterior and posterior fusion is essential in neuropathic spinal arthropathy. Congenital insensitivity to pain can manifest problems into adulthood.
authors.affiliation: University of Kentucky Medical Center, K-401, Kentucky Clinic, 740 South Limestone Street, Lexington, KY 40536, USA. rccass2@uky.edu
authors.forename: R Carter
authors.initials: RC
authors.lastname: Cassidy
authors.forename: William O
authors.initials: WO
authors.lastname: Shaffer
mesh_terms: D000328:Adult; D001177:Arthropathy, Neurogenic / Q000209:etiology* / Q000601:surgery; D019299:Decompression, Surgical; D006785:Hospitals, University; D006801:Humans; D008297:Male; D000699:Pain Insensitivity, Congenital / Q000150:complications* / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome