Posttraumatic Charcot (Neuropathic) Spinal Arthropathy at the Cervicothoracic Junction

Area of Science:

• Spine Surgery
• Neurotrauma
• Orthopedic Surgery

Background:

• Charcot spine arthropathy (posttraumatic neuroarthropathy) is a rare, late complication of spinal cord injury (SCI).
• It can manifest as progressive spinal deformity up to 30 years post-SCI, particularly in ambulatory paraplegics.
• Cervicothoracic and upper thoracic Charcot spine arthropathy are infrequently reported.

Observation:

• A 56-year-old male with 20-year history of complete paraplegia presented with severe thoracolumbar kyphosis and instability.
• The patient developed new neuroarthropathies at multiple spinal levels post-decompression and fusion surgeries.
• Three surgical interventions were performed over two years to address thoracic, lumbar, and cervicothoracic junction involvement.

Findings:

• Surgical instrumentation of secondary Charcot spinal arthropathy presents significant challenges.
• Neuroarthropathy development above the initial SCI level and at the cervicothoracic junction is rare.
• Recurrent neuroarthropathy occurred despite previous surgical fusions.

Implications:

• Surgeons must consider the potential for developing secondary neuroarthropathies at adjacent or distant spinal levels.
• Awareness of this rare complication is crucial for managing patients with a history of SCI.
• Effective surgical strategies for Charcot spine arthropathy require careful consideration of potential recurrence and progression.