Charcot Spinal Arthropathy Secondary to Spinal Cord Injury - A Case Report

Charcot spinal neuroarthropathy is a progressive destructive vertebral disease characterized by a loss of pain sensation and proprioception. Diagnosing this condition is particularly challenging because symptoms can appear at widely varying times and the neurological symptoms and imaging findings are non-specific. In contemporary cases, Charcot spine is often associated with chronic traumatic spinal cord injuries, in which the lack of proper sensation can hide the early signs of discovertebral destruction, making it even more difficult to promptly diagnose and treat.

A 47-year-old female with a history of American Spinal Injury Association Grade A spinal cord injury presented with dysreflexia, postural changes, and imaging findings consistent with Charcot spine at the T11-T12 level. The patient underwent a successful posterior instrumented spinal fusion. Two years later, the patient presented with worsening pain and dysreflexia and was consequently diagnosed with a second Charcot spine at the L3-L4 level requiring an L3-pelvis fixation.

Charcot spinal arthropathy is a complex diagnosis of exclusion based on history and histopathologic and radiologic findings. This case adds to a very limited number of reports exploring the long-term outcomes of surgical management in Charcot spine and highlights the need for examining the relationship between surgical fusion and acceleration of vertebral joint destruction in hopes to help establish future management guidelines.