Charcot spinal disease after spinal cord injury

Clinical article

Masahiro Morita M.D. 1 , Akira Miyauchi M.D., Ph.D. 1 , Shinya Okuda M.D., Ph.D. 1 , Takenori Oda M.D., Ph.D. 1 , Tomio Yamamoto M.D., Ph.D. 2 and Motoki Iwasaki M.D., Ph.D. 3
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  • 1 Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka;
  • 2 Department of Orthopaedic Surgery, Amagasaki Chuo Hospital, Hyogo; and
  • 3 Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Object

The authors investigated the background, risk factors, and treatment strategies for Charcot spinal disease (CSD) after spinal cord injury (SCI).

Methods

The authors retrospectively examined the clinical and radiological findings in 9 patients with a total of 10 Charcot spine lesions that occurred after SCI. The mean age of the 9 patients was 54 years, and all patients presented with complete SCIs. In all but 1 patient, symptoms did not develop until 10 years postinjury. All 10 Charcot spine lesions were located below the thoracolumbar junction. Surgical treatment was performed in 7 patients (7 lesions), and the mean duration of postoperative follow-up was 84 months.

Results

All patients reported audible noises when changing posture, 5 of 9 patients reported low-back pain, and 7 patients displayed increasing instability while sitting. In 8 patients, spasticity disappeared and limbs became flaccid several years after SCI. Two patients had associated bacterial infections in the Charcot spine lesions, and 1 patient complained of autonomic dysreflexic symptoms associated with trunk movements. Although postoperative complications occurred in 3 patients, all patients who underwent surgical treatment made a good recovery and were able to return to daily life in a wheelchair. On lateral radiography, the mean range of motion at the lesion site was 43°, and fluid collections between the involved vertebrae were observed in 8 patients on MR images; ankylosing spinal hyperostosis was observed in 7 patients. Charcot spine lesions tended to occur at the junction between or at the end of an ankylosing spinal hyperostotic lesion. Postoperatively, solid arthrodesis was obtained within 6 months in all surgically treated lesions.

Conclusions

Disappearance of spasticity in the lower extremities is thought to be an important physical sign suggestive of CSD after SCI. Sitting imbalance and the fluid volume of the Charcot spinal lesions are related to range of motion at the lesion site. In addition to a combined approach, a single posterior approach with acquisition of anterior support is an option for surgical treatment even in cases of infected CSD.

Abbreviations used in this paper: ASH = ankylosing spinal hyperostosis; CSD = Charcot spine disease; MRSA = methicillin-resistant Staphylococcus aureus; ROM = range of motion; SCI = spinal cord injury; VB = vertebral body.

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Contributor Notes

Address correspondence to: Masahiro Morita, M.D., Department of Orthopaedic Surgery, Izumi City Hospital, 4-10-10 Fuchu, Izumi City, Osaka, 594-0071, Japan. email: m1908130@msic.med.osaka-cu.ac.jp.
  • 1

    Arnold PM, , Baek PN, , Stillerman CB, , Rice SG, & Mueller WM: Surgical management of lumbar neuropathic spinal arthropathy (Charcot joint) after traumatic thoracic paraplegia: report of two cases. J Spinal Disord 8:357362, 1995

    • Search Google Scholar
    • Export Citation
  • 2

    Boachie-Adjei O, & Bullough PG: Incidence of ankylosing hyperostosis of the spine (Forestier's disease) at autopsy. Spine 12:739743, 1987

    • Search Google Scholar
    • Export Citation
  • 3

    Briggs JR, & Freehafer AA: Fusion of the Charcot spine. Report of 3 cases. Clin Orthop Relat Res 53:8393, 1967

  • 4

    Brown CW, , Jones B, , Donaldson DH, , Akmakjian J, & Brugman JL: Neuropathic (Charcot) arthropathy of the spine after traumatic spinal paraplegia. Spine 17:6 Suppl S103S108, 1992

    • Search Google Scholar
    • Export Citation
  • 5

    Burkus JK, , Missouri SL, & Denis F: Hyperextension injuries of the thoracic spine in diffuse idiopathic skeletal hyperostosis. J Bone Joint Surg Am 76:237243, 1994

    • Search Google Scholar
    • Export Citation
  • 6

    Crim JR, , Bassett LW, , Gold RH, , Mirra JM, , Mikulics M, & Dawson EG, : Spinal neuroarthropathy after traumatic paraplegia. AJNR Am J Neuroradiol 9:359362, 1988

    • Search Google Scholar
    • Export Citation
  • 7

    Devlin VJ, , Ogilvie JW, , Transfeldt EE, , Boachie-Adjei O, & Bradford DS: Surgical treatment of neuropathic spinal arthropathy. J Spinal Disord 4:319328, 1991

    • Search Google Scholar
    • Export Citation
  • 8

    Glennon TP, , Madewell JE, , Donovan WH, , Bontke CF, & Spjut HJ: Neuropathic spinal arthropathy after spinal cord injury. Spine 17:964971, 1992

    • Search Google Scholar
    • Export Citation
  • 9

    Harrison MJ, , Sacher M, , Rosenblum BR, & Rothman AS: Spinal Charcot arthropathy. Neurosurgery 29:273277, 1991

  • 10

    Hoppenfeld S, , Gross M, & Giangarra C: Nonoperative treatment of neuropathic spinal arthropathy. Spine 15:5456, 1990

  • 11

    Kalen V, , Isono SS, , Cho CS, & Perkash I: Charcot arthropathy of the spine in long-standing paraplegia. Spine 12:4247, 1987

  • 12

    Kapila A, & Lines M: Neuropathic spinal arthropathy: CT and MR findings. J Comput Assist Tomogr 11:736739, 1987

  • 13

    Le Hir PX, , Sautet A, , Le Gars L, , Zeitoun F, , Tubiana JM, & Arrive L, : Hyperextension Vertebral body fractures in diffuse idiopathic skeletal hyperostosis. AJR Am J Roentgenol 173:16791683, 1999

    • Search Google Scholar
    • Export Citation
  • 14

    Luke DL, & Bridwell KH: “Silent” spinal dislocation in Charcot spine occurring postlaminectomy: case report and review of literature”. J Spinal Disord 3:8792, 1990

    • Search Google Scholar
    • Export Citation
  • 15

    McBride GG, & Greenberg D: Treatment of Charcot spinal arthropathy following traumatic paraplegia. J Spinal Disord 4:212220, 1991

  • 16

    Mikawa Y, , Watanabe R, , Yamano Y, & Morii S: Infected Charcot spine following spinal cord injury. Spine 14:892895, 989, 1989

  • 17

    Miyamoto K, , Shimizu K, , Arimoto R, , Sakaguchi Y, , Nishimoto H, & Kodama H, : Spontaneous symptomatic pseudoarthrosis at the T11–T12 intervertebral space with diffuse idiopathic skeletal hyperostosis: a case report. Spine 28:E320E322, 2003

    • Search Google Scholar
    • Export Citation
  • 18

    Mohit AA, , Mirza S, , James J, & Goodkin R: Charcot arthropathy in relation to autonomic dysreflexia in spinal cord injury: case report and review of the literature. J Neurosurg Spine 2:476480, 2005

    • Search Google Scholar
    • Export Citation
  • 19

    Montgomery TJ, & McGuire RA: Traumatic neuropathic arthropathy of the spine. Orthop Rev 22:11531157, 1993

  • 20

    Paley D, , Schwartz M, , Cooper P, , Harris WR, & Levine AM: Fracture of the spine in diffuse idiopathic skeletal hyperostosis. Clin Orthop Relat Res 267:2232, 1991

    • Search Google Scholar
    • Export Citation
  • 21

    Pritchard JC, & Coscia MF: Infection of a Charcot spine. Spine 18:764767, 1993

  • 22

    Rose DM, , Hilton AI, & Tucker SK: Charcot spinal arthropathy in a paraplegic weight lifter. Spine 31:E339E341, 2006

  • 23

    Schwartz HS: Traumatic Charcot spine. J Spinal Disord 3:269275, 1990

  • 24

    Selmi F, , Frankel HL, , Kumaraguru AP, & Apostopoulos V: Charcot joint of the spine, a cause of autonomic dysreflexia in spinal cord injured patients. Spinal Cord 40:481483, 2002

    • Search Google Scholar
    • Export Citation
  • 25

    Shibata T, , Tada K, & Hashizume C: The results of arthrodesis of the ankle for leprotic neuroarthropathy. J Bone Joint Surg Am 72:749756, 1990

    • Search Google Scholar
    • Export Citation
  • 26

    Slabaugh PB, & Smith TK: Neuropathic spine after spinal cord injury. J Bone Joint Surg Am 60:10051006, 1978

  • 27

    Sobel JW, , Bohlman HH, & Freehafer AA: Charcot's arthropathy of the spine following spinal cord injury. J Bone Joint Surg Am 67:771776, 1985

    • Search Google Scholar
    • Export Citation
  • 28

    Staloch MA, & Hatem SF: Charcot spine. Emerg Radiol 14:265269, 2007

  • 29

    Standaert C, , Cardenas DD, & Anderson P: Charcot spine as a late complication of traumatic spinal cord injury. Arch Phys Med Rehabil 78:221225, 1997

    • Search Google Scholar
    • Export Citation
  • 30

    Suda Y, , Saito M, , Shioda M, , Kato H, & Shibasaki K: Infected Charcot spine. Spinal Cord 43:256259, 2005

  • 31

    Suda Y, , Shioda M, , Kohno H, , Machida M, & Yamagishi M: Surgical treatment of Charcot spine. J Spinal Disord Tech 20:8588, 2007

  • 32

    Thomason K, , Emran IM, & Chan D: Shortening osteotomy for the treatment of spinal neuroarthropathy following spinal cord injury. A case report and literature review. Eur Spine J 16:318321, 2007

    • Search Google Scholar
    • Export Citation
  • 33

    Thumbikat P, , Ravichandran G, & McClelland MR: Neuropathic lumbar spondylolisthesis: a rare trigger for posture induced autonomic dysreflexia. Spinal Cord 39:564567, 2001

    • Search Google Scholar
    • Export Citation
  • 34

    Tosi L, , Righetti C, , Terrini G, & Zanette G: Atypical syndromes caudal to the injury site in patients following spinal cord injury. A clinical, neurophysiological and MRI study. Paraplegia 31:751756, 1993

    • Search Google Scholar
    • Export Citation
  • 35

    Vialle R, , Mary P, , Tassin JL, , Parker F, & Guillaumat M: Charcot's disease of the spine: diagnosis and treatment. Spine 30:E315E322, 2005

    • Search Google Scholar
    • Export Citation
  • 36

    Werner JG, & Holt RT: Neuropathic spinal arthropathy: a case history and six year follow-up. J Ky Med Assoc 93:4852, 1995

  • 37

    Wirth CR, , Jacobs RL, & Rolander SD: Neuropathic spinal arthropathy: a review of the Charcot spine. Spine 5:558568, 1980

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