"Silent" spinal dislocation in a Charcot spine occurring postlaminectomy: case report and review of literature

A 45-year-old man with transverse myelitis developed an unstable neuropathic spinal arthropathy manifesting as a "silent" L1-L2 dislocation after laminectomy and rhizotomies performed for increased spasticity. Treatment consisted of reduction, posterolateral spinal fusion with Cotrel-Dubousset instrumentation utilizing hooks and pedicular screws, and a posterior lumbar interbody fusion. The authors conclude that laminectomy on a chronic paralytic through the insensate area should be coupled with fusion and instrumentation even if the facet joints and capsules are preserved during the laminectomy.