[Neurogenic senile vertebral spondylopathy]

Neurogenic spinal arthropathy is quite frequent a finding in elderly patients. Peripheral neuropathy underlies this complication. As a matter of fact, impaired proprioception and sensitivity, which are often associated with lesions of the motor nerves, prevent the joint or bone segment submitted to repeated traumas from perceiving alarm sensations, especially pain. Thus, bone lesions follow, which present as bone erosions, fractures, and even more severe bone destruction. At first, tabetic neuropathy was held responsible for this condition. Then, neurogenic arthropathy was observed in diabetes, syringomyelia, and sometimes trauma. However, in the elderly patient, other conditions can cause peripheral neuropathy, which accounts for the high incidence of this disorder. The radiologic findings of the lumbar spine of 23 of 4,922 patients examined in our department 1989 to 1991 were suggestive of neurogenic spinal arthropathy. Clinical, laboratory and electromyographic findings confirmed the presence of neuropathy. Besides the neurogenic lesions described in 7 diabetic patients, these lesions are reported for the first time in 4 cases of multiple myeloma, in a case of Waldenström's macroglobulinemia, in 2 cases of vincristine-treated lymphoma, and finally in an alcohol abuser. Analgesic abuse was observed in 2 patients. In the extant cases, the pathogenesis of neuropathy remained unknown, even though "elderly neuropathy" is known to exist and to be underlain by vascular or degenerative conditions.