Study design: Case report. Objectives: Description of a rare trigger for autonomic dysre¯exia. Setting: Princess Royal Spinal Injuries Unit, She eld. Methods and Results: A case of Charcot's spine (neuropathic spinal arthropathy) in a woman with a traumatic T5 paraplegia is described. She developed symptoms of autonomic dysre¯exia, brought on by changes in posture. The postural variation was attributable to a freely mobile neuropathic spondylolisthesis at the L4/5 level. A laminectomy performed for the implantation of a sacral anterior root stimulator was identi®ed as a causative factor in the development of the neuropathic joint. Surgical stabilisation and fusion resulted in amelioration of her symptoms. Conclusion: Neuropathic spine is a rare cause of autonomic dysre¯exia that should be considered when other more common factors have been excluded. The development of Charcot's spine in the spinal cord injured population is facilitated by surgical procedures involving the vertebrae. Spinal Cord (2001) 39, 564 ± 567
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