title: Sitting imbalance cause and consequence of post-traumatic Charcot spine in paraplegic patients.
abstract: OBJECTIVE
  To analyze the role of spine alignment in post-traumatic paraplegic patient as a potential cause of late Charcot spine disease (CSD).
  
  
  METHODS
  A retrospective review of three cases in which the disease appeared more than 15 years after a spinal cord injury treated by posterior fusion. A review of the literature concerning spine balance in sitting position, especially referred to paraplegic patients, is done to validate this hypothesis.
  
  
  RESULTS
  Lumbar kyphosis in paraplegic patients during the sitting position may increase the mechanical load on disks and ligament below the previously fused area. This phenomenon, in combination with lack of protective mechanism because of poor muscular support and lack of sensitivity can speed up and amplify the normal degenerative changes in the disk and ligaments.
  
  
  CONCLUSIONS
  More investigations are required to fully understand all the mechanisms underlying CSD pathogenesis to prevent it. Until then, a systematic long-term clinical and radiological follow-up in all post-trauma paraplegic patients is suggested. Combined anterior and posterior fusion, when feasible, can restore the sagittal balance providing a better quality of life in these patients.
authors.affiliation: Department of Spine Surgery, Ospedale Maggiore, Largo Nigrisoli 2, 40100, Bologna, Italy, federicodeiure@acantho.it.
authors.forename: Federico
authors.initials: F
authors.lastname: De Iure
authors.forename: Mohammadreza
authors.initials: M
authors.lastname: Chehrassan
authors.forename: Michele
authors.initials: M
authors.lastname: Cappuccio
authors.forename: Luca
authors.initials: L
authors.lastname: Amendola
mesh_terms: D000328:Adult; D001177:Arthropathy, Neurogenic / Q000209:etiology*; D006801:Humans; D007738:Kyphosis / Q000150:complications / Q000000981:diagnostic imaging; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000150:complications*; D011187:Posture; D011788:Quality of Life; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications* / Q000601:surgery; D013122:Spinal Diseases / Q000209:etiology*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000601:surgery; D014057:Tomography, X-Ray Computed