Sitting imbalance cause and consequence of post-traumatic Charcot spine in paraplegic patients

Iure, Federico De; Chehrassan, Mohammadreza; Cappuccio, Michele; Amendola, Luca

doi:10.1007/s00586-014-3550-1

Cited by 12 publications

(8 citation statements)

References 19 publications

(18 reference statements)

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“…5 In paraplegic patients lumbar lordosis is flattened and kyphosis might develop, which may intensify further degenerative changes. 13,14 This explains the predominance of the mentioned spine areas (as also seen in cases 1-4), where the L3/4 segment seems to be affected the most. 4 Other risk factors may include spinal fusion and laminectomy for the treatment of SCI as well as very active paraplegic patients.…”

Section: Discussionmentioning

confidence: 67%

“…Sitting imbalance, an audible cracking noise upon transfer, pain in an otherwise insensitive area and a change in the neurological status seem to be the most frequent ones. 3,4,8,13 Noteworthy changes in the spasticity, usually toward a flaccid paralysis might occur at the time of CSA diagnosis. 3 Interestingly patient 2 presented with increased spasticity, but this might have also been present due to a urinary tract infection at that time.…”

Section: Discussionmentioning

confidence: 99%

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

Grassner

Geuther

Mach

et al. 2015

Spinal Cord Ser Cases

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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.

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Section: Discussionmentioning

confidence: 67%

Section: Discussionmentioning

confidence: 99%

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

Grassner

Geuther

Mach

et al. 2015

Spinal Cord Ser Cases

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“…There is some controversy in the literature concerning spinopelvic alterations in SCI patients with upper thoracic injury level [21,22], while there is a paucity of literature that directly addresses sagittal imbalance in paraplegic patients. Some studies have shown significant alterations of the sagittal thoracolumbopelvic but not of the cervical alignment parameters in the nonambulatory paraplegic patients compared to ambulatory patients, depending on the level of the SCI [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Quality of Life in Adult Patients Receiving Cervical Fusion for Fresh Subaxial Cervical Injury: The Role of Associated Spinal Cord Injury

Korovessis

Mpountogianni

Syrimpeis

et al. 2021

BioMed Research International

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Purpose. To study postoperative Health-Related Quality of Life (HRQOL) after instrumented fusion for fresh subaxial cervical trauma and the effect of spinal cord injury (SCI). Methods. From a total of 65 patients, 17 (26%) patients suffered on admission from SCI. Twenty-five patients underwent anterior, 25 posterior, and 15 circumferential cervical surgery for a single cervical injury. Sagittal roentgenographic parameters were measured in 65 age-matched asymptomatic controls and in patients on admission, eight months postoperatively and at final follow-up (lower C2-C7 curvature, cervical sagittal vertical axis (cSVA), spinocranial angle (SCA), T1-slope, neck tilt (NT), thorax inlet angle (TIA), cervical tilt (CT), cranial tilt (CrT), and occiput–C2 angle (C0-C2)). In the last evaluation, SCI patients were compared with their counterparts without SCI using national validated HRQOL instruments (SF-36 and neck disability index (NDI)). Results. Fusion included an average of 3 vertebrae (range 2-4 vertebrae). All 65 patients were followed for an average of 5.5 years, (range 3-7 years) postoperatively. In the last evaluation, 10 (15.4%) patients with incomplete SCI improved postoperatively at 1-2 grades. At the last observation, patients with SCI showed poorer HRQOL scores than their counterparts without SCI. In particular, each SF-36 domain score was correlated with SCA, T1-slope, cSVA, and CT. At baseline, patients showed higher NT, CrT, and C0-C2 angle than controls. Eight months postoperatively, cSVA, NT, TIA, and cranial tilt (CrT) were increased in patients. In the last observation, there was difference in the sagittal roentgenographic parameters between patients with SCI compared to those without SCI. Patients aged ≥55 years had postoperatively increased cSVA, NT, and CrT compared to their younger counterparts. Conclusion. At the final observation, HRQOL scores were lower in patients with SCI than in their non-SCI counterparts, obviously because of the associated neurologic impairment. SF-36 scores correlated with several sagittal roentgenographic parameters. These correlations should be taken in consideration by spine surgeons when performing cervical spine surgery for fresh cervical spine injuries.

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“…Currently, with advances in medical care, traumatic spinal cord injuries are the leading cause of CSA [2,5]. Between 1978 and 2018, over 140 post-traumatic CSA cases have been reported in the literature [2,[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24].…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal fluid-cutaneous fistula associated with post-traumatic Charcot spinal arthropathy: a case report and review of literature

Ryu

Lee

Lim

et al. 2020

BMC Musculoskelet Disord

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Background: Charcot spinal arthropathy, also known as Charcot spine and neuropathic spinal arthropathy, is a progressive and destructive condition that affects an intervertebral disc and the adjacent vertebral bodies following loss of spinal joint innervation. We report the first case of Charcot spinal arthropathy (CSA) associated with cerebrospinal fluid (CSF)-cutaneous fistula. Case presentation: A 54-year-old male who underwent T10-L2 posterior instrumented spinal fusion seven years prior for treatment of T11 burst fracture and accompanying T11 complete paraplegia visited our department complaining of leakage of clear fluid at his lower back. The patient had also undergone various types of skin graft and myocutaneous flap surgeries for treatment of repetitive pressure sores around his lumbosacral area. The patient presented with persistent CSF leakage from a cutaneous fistula (CSF-cutaneous fistula) formed in a lumbosacral pressure sore. The CSF-cutaneous fistula arose from the L5 post-traumatic CSA. Surgery was planned for management of CSF-cutaneous fistula and post-traumatic L5 CSA. We successfully treated the CSF-cutaneous fistula with ligation and transection of the dural sac and cauda equina at the L2-L3 level. In addition, the post-traumatic L5 CSA was successfully treated with a posterior four-rod spinopelvic fixation from T9 to ilium and S2 foramina. After surgery, the CSF leakage stopped and no other adverse neurological changes were found. The four-rod spinopelvic construct was well maintained five years later. Conclusions: CSA associated with CSF-cutaneous fistula is a very rare disorder. Only surgical treatment for both CSA and CSF-cutaneous fistula with ligation and transection of the dural sac and posterior four-rod spinopelvic fixation can bring satisfactory results.

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Sitting imbalance cause and consequence of post-traumatic Charcot spine in paraplegic patients

Cited by 12 publications

References 19 publications

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

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

Quality of Life in Adult Patients Receiving Cervical Fusion for Fresh Subaxial Cervical Injury: The Role of Associated Spinal Cord Injury

Cerebrospinal fluid-cutaneous fistula associated with post-traumatic Charcot spinal arthropathy: a case report and review of literature

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