Characteristics and surgical management of neuropathic (Charcot) spinal arthropathy after spinal cord injury.
BACKGROUND
Neuropathic (Charcot) spinal arthropathy (CSA) is a rare but progressive and severe degenerative disease that develops in the absence of deep sensation, for example, after spinal cord injury. The diagnosis of CSA is often delayed as a result of the late onset or slow progression of the disease and the nonspecific nature of the reported clinical signs. Considering risk factors of CSA in combination with the common clinical signs may facilitate timely diagnosis and prevent severe presentation of the disease. However, there is a lack of data concerning the early signs and risk factors of CSA. Furthermore, the complications and outcomes after surgical treatment are documented insufficiently.


OBJECTIVE
To investigate the early signs and risk factors of CSA after spinal cord injury, as well as the complications and outcome after surgical treatment.


METHODS
Retrospective case series from a single center.


METHODS
Twenty-eight patients with 39 Charcot joints of the spine.


METHODS
Clinical signs, radiological signs, risk factors, and complications.


METHODS
The case histories and radiological images of patients suffering from CSA were investigated.


RESULTS
The first clinical symptoms included spinal deformity, sitting imbalance, and localized back pain. Long-segment stabilization, laminectomy, scoliosis, and excessive loading of the spine were identified as risk factors for the development of the disease. Postoperative complications included implant loosening, wound healing disturbance, and development of additional Charcot joints. All patients were able to return to their previous levels of activities.


CONCLUSIONS
Radiological follow-up of the entire thoracic and lumbar spine should be performed in paraplegic patients. Risk factors in combination with typical symptoms should be considered to facilitate early detection. Functional restoration can be achieved with appropriate surgical techniques.
Orthopaedics and Spinal Surgery, Swiss Paraplegic Centre, Guido A. Zäch Str. 1, CH-6207 Nottwil, Switzerland; Orthopaedic Department, Medical Faculty, University of Basel, Klingelbergstr. 61, CH-4056 Basel, Switzerland; School of Medicine, Griffith University, Gold Coast, 16 High St, Southport, Gold Coast, Queensland 4222, Australia.
Nikolaus
N
Aebli
Orthopaedics and Spinal Surgery, Swiss Paraplegic Centre, Guido A. Zäch Str. 1, CH-6207 Nottwil, Switzerland.
Tobias
T
Pötzel
Clinical Trial Unit, Swiss Paraplegic Centre, Guido A. Zäch Str. 1, CH-6207 Nottwil, Switzerland. Electronic address: joerg.krebs@paranet.ch.
Jörg
J
Krebs
D000328:Adult; D000368:Aged; D002607:Charcot-Marie-Tooth Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000150:complications* / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*
Charcot arthropathy; Charcot spinal arthropathy; Outcome; Risk factors; Spinal cord injury