Long-term follow-up of the surgical management of neuropathic arthropathy of the spine

Brian Haus, Andrew R. Hsu, Eugene S. Yim, Jeffrey J. Meter, Lawrence A. Rinsky

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background Context: No studies have discussed the long-term surgical management and outcomes of Charcot arthropathy of the spine. This case series presents nine patients treated over 30 years. The study hypothesis was that surgery would reduce instability, pain, recurrence, and the need for revision surgery in the long-term, given previous study findings of successful fusion of Charcot spine in the short-term. Purpose: To evaluate the long-term outcomes of surgery for Charcot spine. Study Design/Setting: Retrospective case series. Cases took place at Stanford University Medical Center and Santa Clara Valley Medical Center. Methods: All patients had either complete paraplegia or dense paraparesis with both major motor and sensory deficits. Seven patients developed Charcot spine after spinal instrumentation for trauma, one after scoliosis repair for meningomyelocele, and one after spinal instrumentation for neuromuscular scoliosis caused by birth injury resulting in C6-C7 quadraplegia. Average time between initial instrumentation and development of Charcot spine was 7.6 years. Two patients underwent posterior fusion alone, six had anterior-posterior fusion, and one was managed with thoracolumbar orthosis. Results: Average follow-up was 14.3 years. Revisions were necessary in 75% (6 of 8) of patients for complications including nonunion, new Charcot joints, recurrent hardware failure, and osteomyelitis. Achieving fusion often required multiple operations, and there were no deaths or neurologic complications. Conclusions: Long-term follow-up showed a high rate of revision surgery. Solid fusions often resulted in late breakdown or new junctional Charcot arthropathies. Patients initially fused to the lumbar spine instead of the sacrum or pelvis had a higher rate of developing another Charcot joint. Fusion was often difficult with persistent nonunions and functional deficits because of decreased mobility. We recommend that Charcot spine well tolerated without skin, seating problems, or dysreflexia should be cautiously observed with conservative management. For surgical care, we recommend three-column stabilization with either combined anterior-posterior or all posterior approaches with anterior support to obtain and secure greater long-term stability.

Original languageEnglish (US)
JournalSpine Journal
Volume10
Issue number6
DOIs
StatePublished - Jun 2010
Externally publishedYes

Fingerprint

Joint Diseases
Spine
Neurogenic Arthropathy
Scoliosis
Reoperation
Birth Injuries
Paraparesis
Meningomyelocele
Orthotic Devices
Sacrum
Paraplegia
Osteomyelitis
Pelvis
Nervous System
Recurrence
Pain
Skin
Wounds and Injuries

Keywords

  • Charcot spine
  • Neuropathic arthropathy
  • Revision
  • Scoliosis
  • Three-column stabilization

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Long-term follow-up of the surgical management of neuropathic arthropathy of the spine. / Haus, Brian; Hsu, Andrew R.; Yim, Eugene S.; Meter, Jeffrey J.; Rinsky, Lawrence A.

In: Spine Journal, Vol. 10, No. 6, 06.2010.

Research output: Contribution to journalArticle

Haus, Brian ; Hsu, Andrew R. ; Yim, Eugene S. ; Meter, Jeffrey J. ; Rinsky, Lawrence A. / Long-term follow-up of the surgical management of neuropathic arthropathy of the spine. In: Spine Journal. 2010 ; Vol. 10, No. 6.
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