Major destructive asymptomatic lumbar Charcot lesion treated with three column resection and short segment reconstruction. Case report, treatment strategy and review of literature

Valancius, Kestutis; Garg, Gaurav; Duicu, Madalina; Hansen, Ebbe Stender; Bünger, Cody

doi:10.1051/sicotj/2017056

Cited by 6 publications

(12 citation statements)

References 16 publications

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“…These challenges make the development of additional salvage techniques useful. Several authors have separately reported 3-column spinal shortening when a large defect is present, [7][8][9] as was used in our Case 2. However, the technique of thecal transection and placement of structural graft in the canal represents an additional tool.…”

Section: Discussionmentioning

confidence: 96%

Thecal Transection and Canal Fusion With Structural Allograft for Refractory Charcot Spinal Arthropathy

Sedney

Adams²,

Daffner³

2020

Clinical Spine Surgery: A Spine Publication

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Charcot spinal arthropathy presents significant surgical challenges, with large bony defects and limitations in fixation and reconstruction which are exacerbated in often numerous revision surgeries. These challenges make the development of additional salvage techniques useful. We report on a technique of thecal transection and canal fusion with structural allograft as a salvage technique for refractory cases of Charcot spinal arthropathy. We illustrate the technique with 4 procedures done in 3 patients, over a period of 10 years.

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Section: Discussionmentioning

confidence: 96%

Thecal Transection and Canal Fusion With Structural Allograft for Refractory Charcot Spinal Arthropathy

Sedney

Adams²,

Daffner³

2020

Clinical Spine Surgery: A Spine Publication

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“…Numerous techniques are used for anterior column reconstruction following vertebral resection [12]. Conventionally, a strut autograft is used, either a resected rib, tricortical iliac, fibular strut, or allograft [13,14]. No adequate stability is provided when using ribs.…”

Section: Discussionmentioning

confidence: 99%

“…No adequate stability is provided when using ribs. Being fragile, with high plastic deformation and a small contact area [14]. As for tricortical iliac struts, fashioning the shape and size is difficult, having relatively small weight-bearing surfaces also increased donor site morbidity [15,16].…”

Section: Discussionmentioning

confidence: 99%

Kyphectomy with anterior column reconstruction using titanium mesh cage in meningomyelocele patients

Hussien

Elbadrawi

Zayan

2022

SICOT-J

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Study design: Prospective case series. Purpose: To describe a new technique for anterior column reconstruction after kyphectomy in myelomeningocele patients using titanium mesh cage and to evaluate outcomes and complications. Methods: Sixteen patients with severe dorsolumbar kyphosis 2ry to myelomeningocele were enrolled with a mean age of 10.1 years. Kyphectomy procedure and long spinopelvic fixation were done, titanium mesh cage was used to reconstruct the anterior column. Operative time and intraoperative blood loss were calculated. Using the Cobb method, pre and postoperative measurements of local/regional kyphosis were done. Degree and mean percentage of correction were calculated. Anterior intervertebral height of the kyphotic area was also measured. The mean follow-up period was 27 months. Results: Operative time was 271.3 min ± 25, and estimated intraoperative blood loss was 781.3 mL ± 92.3. On average, 2.5 vertebrae were resected. All 16 patients were able to lie supine immediately postoperatively. The mean preoperative local/regional kyphosis was 107.5°, and 106.9° respectively, corrected to 22.5° and 28.8° postoperatively, with a mean degree of correction of 85° and 78.1° respectively. Mean preoperative anterior intervertebral height was 3.54 cm, improved to 4.64 cm postoperatively. Only 2 cases had a superficial wound infection managed conservatively. At the latest follow-up, no loss of correction pseudoarthrosis occurred, and all patients showed solid fusion. Conclusion: Titanium mesh cage is an efficient, easy method for anterior reconstruction following kyphectomy in myelomeningocele patients, to maintain postoperative correction. Level of evidence: Therapeutic studies, Level IV study

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“…Additional stability may be achieved through the addition of extra rods (eg, four-rod or more rod constructs) and increasing the diameter of the rod 28,29 using stiffer materials (eg, cobalt chrome plus over titanium products). 28 Multiple previous publications 19,21,22 detail these surgical techniques in various presentations of Charcot spine arthropathy. Although fixed angle screws add stability, it may increase the difficulty of passing the rod across the site of Charcot.…”

Section: Surgical Treatment Considerations For Charcot Spinal Arthrop...mentioning

confidence: 99%

Charcot Arthropathy of the Spine

Farrugia

Bednar

Oitment

2022

J Am Acad Orthop Surg

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Charcot arthropathy of the spine (CSA), also known as spinal neuroarthropathy, is a progressive disease process in which the biomechanical elements of stability of the spine are compromised because of the loss of neuroprotection leading to joint destruction, deformity, and pain. Initially thought to be associated with infectious causes such as syphilis; however in the latter part of the century, Charcot arthropathy of the spine has become associated with traumatic spinal cord injury. Clinical diagnosis is challenging because of the delayed presentation of symptoms and concurrent differential diagnosis. Although radiological features can assist with diagnosis, the need for recognition and associated treatment is vital to limit the lifelong disability with the disease. The goals of treatment are to limit symptoms and provide spinal stabilization. Surgical treatment of these patients can be demanding, and alternative techniques of instrumentation are often required. Charcot arthropathy may affect all axial and peripheral joints with the knee, foot, and spine being predominantly affected. 1 Also known as spinal neuroarthropathy (SNA), Charcot spinal arthropathy is a progressive disorder involving a destructive process of the anatomical elements which provide spinal stability. Clinical recognition is often delayed and difficult. 1 The mobile thoracolumbar and lumbosacral junctions of the spine are the most common areas affected. 2 Involvement of the cervical, thoracic, or sacral regions is exceptional. 1 The pathophysiology of this disorder can mimic an infectious or malignant process. Therefore, it is paramount to be aware of the clinical and radiographic specific features and varied treatment options for Charcot spinal arthropathy. 1,2 EpidemiologyCharcot arthropathy was described by Jean-Marie Charcot in 1868, 2 in his observations of patients with joint arthropathies experiencing sharp, quick pains before the ensuing joint destruction and eventual development of ataxia. 3 Charcot arthropathy of the spine (CSA) was first described in the 1800s by physicians Mitchell and Kronig 4,5 in case reports of associations between patients with spinal cord lesions due to syphilis and incidences of peripheral neuropathy. With the modernized treatment for syphilis and

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Major destructive asymptomatic lumbar Charcot lesion treated with three column resection and short segment reconstruction. Case report, treatment strategy and review of literature

Cited by 6 publications

References 16 publications

Thecal Transection and Canal Fusion With Structural Allograft for Refractory Charcot Spinal Arthropathy

Thecal Transection and Canal Fusion With Structural Allograft for Refractory Charcot Spinal Arthropathy

Kyphectomy with anterior column reconstruction using titanium mesh cage in meningomyelocele patients

Charcot Arthropathy of the Spine

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