The Journal of the American Academy of Orthopaedic Surgeons
Charcot Arthropathy of the Spine
Aug 25, 2022
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5 min
Charcot arthropathy of the spine (CSA), also known as spinal neuroarthropathy, is a rare but devastating condition characterized by progressive joint destruction, spinal instability, and deformity. Historically linked to infections like syphilis, modern cases are now primarily associated with traumatic spinal cord injuries (SCI). The disease develops due to a loss of neuroprotective mechanisms, leading to unchecked mechanical stress and degenerative changes in spinal joints.
Key Features and Diagnostic Challenges
CSA often presents with delayed symptoms, complicating early diagnosis. Patients may report chronic pain, spinal deformity, or neurological deficits, but these signs can mimic other conditions like infections or tumors. Radiological imaging (CT, MRI, or X-rays) is critical for identifying hallmark features such as:
Severe joint destruction
Bone fragmentation
Spinal instability
Heterotopic ossification
Despite imaging clues, CSA remains underrecognized, emphasizing the need for clinical suspicion in high-risk patients, particularly those with long-standing SCI.
Treatment Goals and Surgical Complexity
The primary objectives of CSA management are pain relief and spinal stabilization. Non-surgical options (bracing, activity modification) may help in early stages, but advanced cases often require surgical intervention. Surgery is technically demanding due to:
Severe bone loss and poor fixation points
Pre-existing deformities and instability
High risk of hardware failure or pseudoarthrosis
Surgeons may employ alternative techniques such as extended posterior fixation, anterior column reconstruction, or augmented instrumentation to achieve stability. Long-term outcomes depend on halting disease progression and restoring spinal alignment.
Why This Matters for Healthcare Professionals
CSA poses unique challenges due to its insidious onset and complex pathology. Early recognition and intervention are critical to prevent irreversible disability. For clinicians, this underscores the importance of:
Monitoring SCI patients for delayed spinal degeneration
Combining clinical, radiological, and biomechanical assessments
Adopting tailored surgical strategies for high-risk cases
This condition highlights the intersection of neurology, orthopedics, and rehabilitation medicine, making it a critical topic for specialists managing spinal disorders or chronic SCI complications.
Colby Oitment, Patricia Ruth Farrugia, Drew Bednar
