Onset of a Charcot spinal arthropathy at a level lacking surgical arthrodesis in a paraplegic patient with traumatic cord injury

Proietti, Luca; Pola, Enrico; Nasto, Luigi Aurelio; Scaramuzzo, Laura; Logroscino, Carlo Ambrogio

doi:10.1007/s00586-009-1055-0

Cited by 10 publications

(6 citation statements)

References 8 publications

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“…Nevertheless, complications represent undesirable consequences of lumbar spine surgery in adult patients. Patients’ age, medical comorbidities and fusion extending up to the sacrum are identified as predisposing risk factors 123456. The development of new guidelines in perioperative nutrition, pulmonary management and intraoperative neuromonitoring have been considered important measures in decreasing the complication rate 78.…”

Section: Introductionmentioning

confidence: 99%

Complications in lumbar spine surgery: A retrospective analysis

Proietti

Scaramuzzo

Schirò

et al. 2013

IJOO

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Background:Surgical treatment of adult lumbar spinal disorders is associated with a substantial risk of intraoperative and perioperative complications. There is no clearly defined medical literature on complication in lumbar spine surgery. Purpose of the study is to retrospectively evaluate intraoperative and perioperative complications who underwent various lumbar surgical procedures and to study the possible predisposing role of advanced age in increasing this rate.Materials and Methods:From 2007 to 2011 the number and type of complications were recorded and both univariate, (considering the patients’ age) and a multivariate statistical analysis was conducted in order to establish a possible predisposing role. 133 were lumbar disc hernia treated with microdiscetomy, 88 were lumbar stenosis, treated in 36 cases with only decompression, 52 with decompression and instrumentation with a maximum of 2 levels. 26 patients showed a lumbar fracture treated with percutaneous or open screw fixation. 12 showed a scoliotic or kyphotic deformity treated with decompression, fusion and osteotomies with a maximum of 7.3 levels of fusion (range 5-14). 70 were spondylolisthesis treated with 1 or more level of fusion. In 34 cases a fusion till S1 was performed.Results:Of the 338 patients who underwent surgery, 55 showed one or more complications. Type of surgical treatment (P = 0.004), open surgical approach (open P = 0.001) and operative time (P = 0.001) increased the relative risk (RR) of complication occurrence of 2.3, 3.8 and 5.1 respectively. Major complications are more often seen in complex surgical treatment for severe deformities, in revision surgery and in anterior approaches with an occurrence of 58.3%. Age greater than 65 years, despite an increased RR of perioperative complications (1.5), does not represent a predisposing risk factor to complications (P = 0.006).Conclusion:Surgical decision-making and exclusion of patients is not justified only by due to age. A systematic preoperative evaluation should always be performed in order to stratify risks and to guide decision-making for obtaining the best possible clinical results at lower risk, even for elderly patients.

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Section: Introductionmentioning

confidence: 99%

Complications in lumbar spine surgery: A retrospective analysis

Proietti

Scaramuzzo

Schirò

et al. 2013

IJOO

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“…Other orthopedic surgeons may have preferred circumferential fusion of the spine. 7,10,12 But the surgical interven-tion decided upon for our patient seemed to be the most adapted to the circumstances.…”

Section: Discussionmentioning

confidence: 92%

Challenge of handling a Charcot spinal arthropathy with a novel hybrid fibular autograft and expandable cage

Ohana¹,

Benharroch

Sheinis³

2018

Journal of Neurosurgery: Spine

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A 26-year-old man, who was paraplegic for 6 years due to a motor vehicle accident, presented to the authors’ clinic following his incapacity to withstand a sitting posture, the frequent sensation of “clicks” in his back, and a complaint of back pain while in his wheelchair. On imaging, his dorsal spine showed a complete arthrodesis of the primarily fused vertebrae. However, distal to this segment, a Charcot spinal arthropathy with subluxation of T12–L1 was evident. Repair of this complex, uncommon, late complication of his paraplegia by the frequently used fusion techniques was shown to be inappropriate. A novel and elaborate surgical procedure is presented by which a complete fusion of the affected spine was secured. A left retrodiaphragmatic approach was used. Complete corpectomy of both the T-12 and L-1 vertebrae to the preserved endplates was performed. Most of the patient’s fibula was resected and shaped for engrafting. The segment of the fibula was introduced into a mesh cage, before its intramedullary implantation into the T-12 and L-1 vertebrae. This 2-step procedure combined the hybrid use of a fibular autograft and an expandable mesh cage, incorporated one into the other, in an innovative intramedullary position. This intervention allowed the patient to resume his former condition as an extremely physically active patient with paraplegia. Nine years later, an asymptomatic early-stage Charcot spine was found at L5–S1, but no treatment is planned at this point.

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“…Surgical options considered with CSA include anterior and posterior circumferential fusion with extensive anterior debridement, posterior instrumentation, and autogenous bone graft. Posterior fixation allows mechanical stability, while biological secondary stability is dependent on bone fusion [8]. In a four-case review, no serious post-operative complication or instrumentation failure was observed [9].…”

Section: Discussionmentioning

confidence: 95%

Neuropathic spinal arthropathy leading to spine disruption, spinal cord transection, and aortic displacement: brief case report

Goetz

McAvoy

Zakrzewski

2018

Spinal Cord Ser Cases

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Introduction Charcot spinal arthropathy (CSA) is an infrequent but potentially devastating complication after spinal cord injury. Case presentation We report a case of a man with longstanding T3 complete (AIS A) paraplegia who developed severe CSA with spine disruption and aortic displacement. Discussion Acute management of this patient is described along with both conservative and surgical management considerations and challenges as described in other reports.

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Onset of a Charcot spinal arthropathy at a level lacking surgical arthrodesis in a paraplegic patient with traumatic cord injury

Cited by 10 publications

References 8 publications

Complications in lumbar spine surgery: A retrospective analysis

Complications in lumbar spine surgery: A retrospective analysis

Challenge of handling a Charcot spinal arthropathy with a novel hybrid fibular autograft and expandable cage

Neuropathic spinal arthropathy leading to spine disruption, spinal cord transection, and aortic displacement: brief case report

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