title: Charcot arthropathy of the spine in spinal cord injured individuals with sacral deafferentation and anterior root stimulator implantation.
abstract: OBJECTIVE
  To investigate the occurrence of Charcot spinal arthropathy (CSA) after sacral deafferentation (SDAF) and sacral anterior root stimulation (SARS) of the bladder in patients suffering from neurogenic lower urinary tract dysfunction (NLUTD) as a result of spinal cord injury (SCI).
  
  
  METHODS
  Retrospective evaluation of patients who had undergone SDAF/SARS at a single SCI rehabilitation centre. The occurrence rate of stimulation dysfunction was determined, and the medical records and radiological images of the included patients were examined for CSA. The diagnosis of CSA was based on radiological criteria. The occurrence rate of CSA was estimated for all SARS patients and for those with SARS dysfunction, and the odds ratios (OR) for the occurrence of CSA were calculated.
  
  
  RESULTS
  In 11/130 SARS patients (8%), CSA was observed a median 8 years (95% CI 5-16 years) after SDAF/SARS or a median 21 years (95% CI 9-41 years) after SCI had occurred. The median follow-up time was 14 years (range 6-25 years). The proportion of patients with CSA was significantly (P = 0.036) greater in patients with SARS dysfunction (7/41) than in patients without SARS dysfunction (4/89). The odds of CSA were four times greater (OR 4.3, 95% CI 1.0-21.5) in patients with SARS dysfunction compared to those without. Furthermore, the odds of CSA were 20 times greater (OR 20.2, 95% CI 8.4-47.0) in patients with SARS compared to those without.
  
  
  CONCLUSIONS
  Charcot spinal arthropathy should be considered a potential long-term complication of SDAF/SARS, and spinal instability is a possible reason for SARS dysfunction.
authors.affiliation: Clinical Trial Unit; Swiss Paraplegic Centre, Nottwil, Switzerland.
authors.forename: Jörg
authors.initials: J
authors.lastname: Krebs
authors.affiliation: Neurourology; Swiss Paraplegic Centre, Nottwil, Switzerland.
authors.forename: Dennis
authors.initials: D
authors.lastname: Grasmücke
authors.affiliation: Spinal Surgery Orthopaedics Swiss Paraplegic Centre, Nottwil, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Pötzel
authors.affiliation: Radiology Swiss Paraplegic Centre, Nottwil, Switzerland.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pannek
mesh_terms: D000293:Adolescent; D000328:Adult; D001177:Arthropathy, Neurogenic / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D001696:Biomechanical Phenomena; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D007796:Laminectomy / Q000009:adverse effects*; D059411:Lower Urinary Tract Symptoms / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D008159:Lumbar Vertebrae / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D058117:Neural Prostheses; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012447:Sacrum / Q000293:injuries / Q000503:physiopathology / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D062187:Spinal Cord Stimulation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult
keywords: charcot arthropathy; charcot spinal arthropathy; neurogenic lower urinary tract dysfunction; neuropathic spinal arthropathy; sacral anterior root stimulation; sacral deafferentation; spinal cord injury