Charcot Arthropathy of the Lumbar Spine Treated Using One-Staged Posterior Three-Column Shortening and Fusion

Abstract

A single-stage, multilevel, posterior 3-column resection and primary shortening can be a useful surgical strategy in symptomatic patients with Charcot arthropathy of the spine.

Charcot spinal arthropathy

“…Because of her multiple anterior surgeries for scoliosis, the authors concluded an anterior approach would produce significant risk to the vessels adjacent to the Charcot segment, due to inflammatory adhesion. [ 21 ] The single-stage, posterior 3-column resection approach used by the authors provides ventral access to the affected vertebral bodies without transecting the thecal sac, through ligation of nonfunctional roots within the Charcot segment. [ 21 ] By permitting direct host-to-host bony contact, the procedure eliminates the need for anterior and posterior column struts, while reducing the number of graft-host sites for the bone union.…”

“…[ 21 ] The single-stage, posterior 3-column resection approach used by the authors provides ventral access to the affected vertebral bodies without transecting the thecal sac, through ligation of nonfunctional roots within the Charcot segment. [ 21 ] By permitting direct host-to-host bony contact, the procedure eliminates the need for anterior and posterior column struts, while reducing the number of graft-host sites for the bone union. The authors believe the single-stage, posterior 3-column resection with primary shortening approach avoids the potential complications of a long anterior cage or allograft segment.…”

“…The authors believe the single-stage, posterior 3-column resection with primary shortening approach avoids the potential complications of a long anterior cage or allograft segment. [ 21 ] The use of BMP, in this case, must be acknowledged, as this biological agent is known to promote union and decrease treatment failure rates. [ 13 ] While these case studies suggest high fusion and low hardware failure rates for single-stage posterior approaches, the results require further investigation due to the nature of their small sample size.…”

“…[ 16 ] In wheelchair-bound patients, a neutral or slightly flexed sagittal position is ideal, as this facilitates proper bladder function. [ 21 ]…”

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

“…A situation where there is a complete transection of the spinal cord with absence of neural elements at the site of the Charcot joint would also facilitate direct access to the anterior column through a single posterior incision2,4,12).…”