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      Charcot spinal arthropathy: an increasing long-term sequel after spinal cord injury with no straightforward management

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          Abstract

          <p class="first" id="d10670768e161">Charcot spinal arthropathy (CSA) is most likely increasing in patients suffering from consequences of spinal cord injury. We want to highlight initial symptoms, certain risk factors and perioperative complications of this condition. A single center retrospective case series in a specialized Center for Spinal Cord Injuries, BG Trauma Center Murnau, Germany highlighting the potential obstacles in the management of Charcot spine. We describe four female paraplegic patients (mean age: 50.75 years; range: 42–67), who developed Charcot spinal arthropathies. The mean age at the time of the accident was 21.5 years (3–35), the time lag after the accident before CSA was developed and finally diagnosed was on average 29.5 years (17–39) and the mean follow-up period was 39.5 months (6–73). Patient histories, initial symptoms, risk factors as well as the management and postoperative complications are provided. Charcot spine is an important potential sequel of spinal cord injury, which can lead to significant disability and spinal emergencies in affected individuals. More studies are needed to provide better recommendations for spine surgeons. Conservative treatment is an option. Posterior fixation alone does not seem to be sufficient. </p>

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          Most cited references21

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          Post-traumatic spinal deformity.

          There are approximately 50,000 fractures to the bony spinal column each year in the United States. The vast majority of unstable spinal injuries are recognized early and managed appropriately. Rarely, the initial treatment may have been inadequate, or in less obvious injuries, less aggressive immobilization techniques may have been chosen. This along with continued exposure to physiologic stresses may lead to a gradual post-traumatic deformity that may further impede the functional as well as emotional status of these often already compromised patients. The management of post-traumatic deformity can be extremely challenging. A post-traumatic kyphotic deformity may occur in the cervical, thoracic, thoracolumbar, or lumbar spine, and once appropriate imaging studies are obtained, careful surgical considerations must be undertaken. Surgical intervention is considered if the kyphotic deformity is progressive over time or there is new onset or progression of a neurologic deficit. Surgical procedures include either a posterior or anterior only approach or any variation of a combined anterior or posterior procedure. In most cases a posterior only fusion is often insufficient for optimal correction and stabilization. Although the majority of patients developing a post-traumatic deformity usually occur after spinal column trauma initially treated nonoperatively, several miscellaneous causes of post-traumatic deformity may occur after surgery. These include nonunion, implant failure, Charcot spine, and technical error. The overall outcome after the surgical management of post-traumatic deformity has been satisfactory with better outcomes in the patients treated earlier as opposed to later. Operative complications include the increased risk of neurologic injury because of the draping of the neural elements over the anterior vertebral elements, any pre-existing spinal cord injury, and possible scarring with cord tethering. Trauma to the spinal cord and column is a devastating injury that may be fraught with many complications including post-traumatic deformity. Certainly, the best treatment is prevention with close follow-up and early intervention when needed. Once present, the treatment of post-traumatic deformity follows basic biomechanical principles consisting of re-establishing the integrity of the compromised spinal columns so that spinal stability can be restored.
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            Charcot spine: two new case reports and a systematic review of 109 clinical cases from the literature.

            The goal of the present work was to report two new clinical cases on Charcot spinal arthropathy (Charcot spine) and to identify and review all cases reported in the literature since 1978.
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              Neuropathic osteoarthropathy: diagnostic dilemmas and differential diagnosis.

              The purpose of this pictorial essay is to illustrate the radiologic spectrum of imaging findings of neuropathic osteoarthropathy. Typical findings include joint destruction, disorganization, and effusion with osseous debris. A variety of other imaging findings related to neuropathic osteoarthropathy such as resorption of the ends of tubular bones and neuropathic fracture are shown. The two prevailing theories for the pathophysiology of neuropathic bone and joint disease, the neurovascular and neurotraumatic theories, are briefly described. Examples of osteoarthropathy from diverse causes are presented including syringomyelia, spinal cord injury, meningomyelocele, diabetes mellitus, congenital insensitivity to pain, steroid injections, syphilis, leprosy, and others. The discussion focuses on key imaging features with emphasis on disease patterns and differential diagnosis, which vary by skeletal location.
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                Author and article information

                Journal
                Spinal Cord Series and Cases
                Spinal Cord Ser Cases
                Springer Nature
                2058-6124
                October 2015
                October 8 2015
                October 2015
                : 1
                : 1
                Article
                10.1038/scsandc.2015.22
                5129447
                28053724
                bc9f8a74-eff9-46e8-bab7-c7fc01d48e2b
                © 2015

                http://www.springer.com/tdm

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