Exceptional Spinal Mobility Caused by Charcot Disease: Case Description with Several Years of Follow‑Up

Indian Journal of Orthopaedics, 2023 · DOI: 10.1007/s43465-023-00937-z · Published: July 1, 2023

Orthopedics Spinal Disorders Research Methodology & Design

Simple Explanation

Charcot Spinal Arthropathy (CSA) is a rare disorder characterized by progressive degeneration of the vertebral joint due to decreased afferent innervation. This condition is now most commonly caused by traumatic Spinal Cord Injury (SCI), leading to increased weight-bearing and mobility in the spine, ultimately destroying the intervertebral joints. The case involves a patient with post-traumatic spinal cord injury, presenting with spinal Charcot disease, which led to the replacement of discal space and vertebral bodies by fibrotic tissue, resulting in extraordinary spinal movement.

Study Duration

Several Years

Participants

One female patient

Evidence Level

Level IV, Case Report

Key Findings

1
The patient exhibited exceptional spinal movement in the coronal and sagittal planes due to the replacement of the discal space and vertebral bodies with fibrotic tissue.
2
A rare complication of CSA was observed, featuring a giant cystic formation and uncommon spinal instability, which was managed with revision surgery involving posterior instrumentation and anterior cage placement.
3
Fusion down to the sacrum (and ilium) is recommended for CSA at or below the thoracolumbar junction to decrease the risk of new-onset CSA.

Research Summary

This case report describes a unique complication of Charcot Spinal Arthropathy (CSA) in a patient with a post-traumatic spinal cord injury, highlighting the replacement of vertebral structures with fibrotic tissue and resulting spinal instability. The patient underwent multiple revision surgeries, and the eventual management included extension of posterior instrumentation to the sacrum and ilium, along with anterior cage placement, leading to a clinically asymptomatic state at the latest follow-up. The authors emphasize the importance of limiting the extent of arthrodesis and conducting regular follow-ups to detect recurrence in CSA patients, recommending fusion to the sacrum or ilium to minimize re-operations.

Practical Implications

Surgical Planning

Limit the extent of initial arthrodesis to minimize stress on adjacent levels and potential for future complications.

Post-operative Monitoring

Implement regular follow-ups to detect early signs of recurrence or new-onset Charcot Spinal Arthropathy.

Fusion Extent

Consider extending fusion to the sacrum or ilium in thoracolumbar CSA cases to reduce the risk of re-operations.

Study Limitations

1
The exact mechanism and vertebral pattern of the initial spinal injury are not known.
2
Single case report limits generalizability
3
Not specified

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