J Korean Neurosurg Soc.  2013 Dec;54(6):532-536. 10.3340/jkns.2013.54.6.532.

Charcot Spine Treated Using a Single Staged Posterolateral Costotransversectomy Approach in a Patient with Traumatic Spinal Cord Injury

• Kim TW
• Seo EM
• Hwang JT
• Kwak BC

• KMID: 2190954
• DOI: http://doi.org/10.3340/jkns.2013.54.6.532

Abstract

Charcot spine is a progressive and destructive process that affects the vertebral bodies, intervertebral discs, and posterior facets. It is the result from repetitive microtrauma in patients who have decreased joint protective mechanisms due to loss of deep pain and proprioceptive sensation, typically because of spinal cord injury. The objective of the study is to report an unusual case of Charcot spine, as a late complication of traumatic spinal cord injury, treated by a circumferential arthrodesis performed with a single staged posterolateral costotransversectomy approach.

Keyword

Charcot spine; Spinal cord injury; Circumferential arthrodesis; Posterolateral costotransversectomy approach

MeSH Terms

Arthrodesis
Humans
Intervertebral Disc
Joints
Sensation
Spinal Cord Injuries*
Spinal Cord*
Spine*

Figure

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  Fig. 1 Thoracolumbar spine (A) AP and (B) lateral radiograph show old fracture of T7, 8 and right ward translation of T11 by extensive destruction of the T11, 12 vertebral columns.

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  Fig. 2 Thoracolumbar (A) coronal and (B) sagittal CT image show three-column bony destruction, and a large complex paraspinal soft tissue with areas of ossifications and peripheral bony debris.

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  Fig. 3 Magnetic resonance imaging scans showing the complexity of the vertebral destruction and paraspinal mass with associated fluid collections. The mass is intermediate signal intensity on T1 weighted image (A), complex with mildly hyperintense areas on T2 weighted image (B).

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  Fig. 4 Photomicrograph shows fibrous and bony tissue with hemosiderin pigment and hyalinization (H&E stain ×100).

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  Fig. 5 Intraoperative photograph shows the posterolateral exposure of the Charcot segment, with a temporary stabilizing rod in place before distraction.

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  Fig. 6 The two years later follow up thoracolumbar sitting (A) AP and (B)lateral radiograph shows solid fusion and good alignment without evidence of hardware loosening.

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  Fig. 7 Thoracolumbar (A) coronal and (B) sagittal CT image shows inadequate preparation of T10 lower and L1 upper end plate, and solid fusion between the residual T11, 12 bodies by a mesh cage.

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