Very early Charcot spinal arthropathy associated with forward bending after spinal cord injury: a case report

Charcot spinal arthropathy (CSA) is an uncommon clinical entity following spinal cord injury (SCI). It is characterized by progressive cartilaginous and bony destruction and is felt to be due to loss of proprioceptive and nociceptive feedback from the spine. CSA is typically diagnosed many years following SCI and has the potential to lead to progressive neurologic decline if left untreated.

We describe the case of a 49-year-old male who fell approximately thirty feet from a ladder and sustained a fracture/dislocation at T3-4 and T8-9 resulting in a T4 ASIA A SCI. He underwent T2-T12 posterior spinal stabilization and, within 1 year and 2 months of initial injury, developed an unusual back protuberance, decreased spasticity, and change in bladder function. The patient's imaging and physical exam were consistent with CSA.

This case is notable in two respects. First, this is one of the earliest cases of CSA identified in the literature. Although CSA is generally considered a late complication of SCI, CSA should be placed in the differential for all individuals with spinal cord presenting with clinical findings typical of CSA. Second, this case was associated with unsupervised attempts to improve range of motion (ROM) in a SCI patient with a fused spine. The association of unsupervised stretching and CSA has not been previously described.