Characteristics and surgical management of neuropathic (Charcot) spinal arthropathy after spinal cord injury

BACKGROUND CONTEXT: 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. PURPOSE: To investigate the early signs and risk factors of CSA after spinal cord injury, as well as the complications and outcome after surgical treatment. STUDY DESIGN: Retrospective case series from a single center. PATIENT SAMPLE: Twenty-eight patients with 39 Charcot joints of the spine. OUTCOME MEASURES: 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. (C) 2014 Elsevier Inc. All rights reserved.