Very early Charcot spinal arthropathy associated with forward bending after spinal cord injury: a case report

Abstract

Introduction Charcot spinal arthropathy (CSA) is an uncommon clinical entity following spinal cord injury (SCI). It is characterized by progressive cartilaginous and bony destruction and is felt to be due to loss of proprioceptive and nociceptive feedback from the spine. CSA is typically diagnosed many years following SCI and has the potential to lead to progressive neurologic decline if left untreated. Case presentation We describe the case of a 49-year-old male who fell approximately thirty feet from a ladder and sustained a fracture/dislocation at T3-4 and T8-9 resulting in a T4 ASIA A SCI. He underwent T2-T12 posterior spinal stabilization and, within 1 year and 2 months of initial injury, developed an unusual back protuberance, decreased spasticity, and change in bladder function. The patient's imaging and physical exam were consistent with CSA. Discussion This case is notable in two respects. First, this is one of the earliest cases of CSA identified in the literature. Although CSA is generally considered a late complication of SCI, CSA should be placed in the differential for all individuals with spinal cord presenting with clinical findings typical of CSA. Second, this case was associated with unsupervised attempts to improve range of motion (ROM) in a SCI patient with a fused spine. The association of unsupervised stretching and CSA has not been previously described.

Early Diagnosis of Late-Onset Below-Level Neuropathic Pain in an 83 Year-Old Incomplete Tetraplegic Patient: A Charcot Spinal Neuro-Arthropathy Case Report

“…Early diagnosis can allow patients to benefit from orthopedic and rehabilitation treatment without waiting for the situation to evolve, as the patient will then necessarily be directed toward surgical treatment [ 14 , 15 ]. This also underlines the importance of conducting regular clinical and radiological follow-up of patients with SCI and focusing on their entire cervico-thoracolumbar spine, not only the initial site of injury [ 16 ]. Finally, it seems important to be able to evoke this neuropathic spinal arthropathy sufficiently in time to prevent its disabling consequences in patients with SCI, in terms of quality of life and independence [ 17 ].…”

MRI-based early diagnosis: a diabetic Charcot spine case report

“…Severe neurological deterioration is common at the moment of diagnosis due to the scarcity of symptoms in SNA’s early stages. Therefore, a precocious diagnosis is very rare – only a few cases have been described in the literature, secondary generally to spinal trauma, as reported in 2019 by Abramoff et al [ 2 ]. Another unusual feature of SNA is diabetes as an underlying cause, reported to be around 2.0% in a 2010 comprehensive review by Barrey et al [ 3 ].…”