Infected charcot spine arthropathy.

Area of Science:

• Spine Surgery
• Infectious Diseases
• Neurology

Background:

• Charcot spinal arthropathy (CSA) is a destructive spinal condition often seen in patients with impaired sensation, particularly those with spinal cord injury (SCI).
• Superimposed infection in CSA complicates diagnosis and management, posing significant challenges.
• Individuals with SCI are at higher risk for developing superimposed infections on their Charcot spine.

Purpose of the Study:

• To report atypical presentations of three cases involving Charcot spinal arthropathy with superimposed infection in patients with spinal cord injury.
• To highlight the diagnostic and management challenges associated with these complex cases.

Main Methods:

• Case series reporting on three patients with spinal cord injury presenting with Charcot spinal arthropathy and superimposed infection.
• Surgical interventions included posterior vertebral column resection (PVCR), debridement, anterior column reconstruction, and posterior stabilization.
• Intraoperative cultures and histopathology were utilized for diagnosis, identifying E. coli, Pseudomonas, and tuberculous infections.

Main Results:

• One patient with T7-8 SCI underwent PVCR of T12 and IV antibiotics for E. coli and Pseudomonas infection.
• A second patient with T12 paraplegia received debridement and anterior column reconstruction for infection and CSA with vertebral destruction.
• The third patient with paraplegia underwent PVCR of L5 and posterior stabilization, with findings suggestive of tuberculous infection.

Conclusions:

• Pyogenic or tuberculous infections of CSA must be considered in patients with SCI due to their increased susceptibility.
• Effective management requires aggressive debridement, circumferential fusion, and appropriate antimicrobial or antitubercular therapy.