Posttraumatic Charcot (Neuropathic) Spinal Arthropathy at the Cervicothoracic Junction

Charcot spine arthropathy (posttraumatic neuroarthropathy of the spine) has been reported to be a very late and rare complication of spinal cord injury. Charcot of the cervicothoracic and upper thoracic region rarely is reported in the literature. Charcot spinal arthropathy is a cause of progressive deformity and may present as late as 30 years after the original spinal cord injury. This is more common in paraplegic patients who are actively ambulating.

A 56-year-old patient with complete paraplegia for approximately 20 years after spinal cord injury presented with severe kyphous deformity and instability of thoracolumbar spine. His sensory level to deep pain was at thoracic (D4). He kept developing new neuroarthropathies at different segments within a span of 5-6 months after every decompression and fusion with anterior cage and posterior instrumentation done. A total of 3 surgeries had been done in span of 2 years, initially thoracic, then lumbar and finally cervicothoracic junction.

We present this case because of the challenges in surgery for instrumentation of new Charcot spinal arthropathy. Reports of neuroarthropathy developing above the level of spinal cord injury and at the cervicothoracic junction are rare. The treating surgeon should be cognizant of the possibility of developing secondary levels of neuroarthropathy above and below a previously successful fusion.