Charcot spinal arthropathy in a diabetic patient

Abstract

We report a case of Charcot spinal arthropathy in a diabetic patient and emphasize the clinical reasoning leading to the diagnosis, discuss the differential diagnosis, and insist on the crucial role of the radiologist and pathologist which allows the distinction between Charcot spinal arthropathy and infectious or tumoural disorders of the spine.

Charcot spinal arthropathy

“…reported a case of a 65-year-old woman with a history of both type 1 diabetes mellitus and Parkinson's disease, but were unable to definitively conclude whether the Parkinson's exacerbated her CSA. [ 9 ] Of note, the patients’ C-reactive protein was elevated at 1.4 mg/dl (normal <1 mg/dl), consistent with the literature on C-reactive protein as a specific diagnostic marker for CSA. [ 13 ] CSA has also been reported in the setting of vascular lesion, such as spinal arteriovenous malformation.…”

“…The neurotraumatic theory hypothesizes that abnormal motion and spinal instability secondary to loss of deep pain and proprioceptive sensation in the posttraumatic SCI vertebral column results in repetitive microtrauma that leads to inflammation of the subchondral bone and articular cartilage. [ 9 14 ] Ultimately, the chronic inflammation results in facet joint destruction, intervertebral disc degeneration, progressive deformity, and spinal instability [ Figure 1 ]. [ 13 ] Conversely, the neurovascular theory describes the onset of hypervascular regions in the subchondral bone due to underlying systemic pathologies such as diabetic neuroarthropathy or autonomic dysfunction.…”

“…[ 18 ] Care must be taken during the differential diagnosis to rule out other progressive destructive spinal pathology, spondylodiscitis, pyogenic spondylitis, metastatic spinal tumor (including both solid and hematological), osteomyelitis, discitis, and Paget's disease. [ 9 13 14 18 19 ] The presence of gas within the disc spaces, also known as the “vacuum phenomenon,” is a diagnostic criteria and can help differentiate CSA from spondylodiscitis. [ 20 ] Tumors can be ruled out through specific immunohistochemistry markers.…”

“…[ 8 ] Less commonly, CSA may present secondary to syringomyelia, meningocele, myelomeningocele, diabetes mellitus, peripheral neuropathies, anesthetic leprosy, congenital analgesia, Parkinson's disease, arachnoiditis, transverse myelitis, and others. [ 8 9 10 11 12 ] In cases of CSA involving gross spinal instability and absence of medical comorbidities that would otherwise cause contraindication, surgery has become the preferred treatment modality. While posterior-only reconstruction has been indicated in mild cases with minimal bony involvement, the majority of CSA today is treated by circumferential arthrodesis.…”

Surgical management of a complex case of Charcot arthropathy of the spine: a case report

“…Any insult to the vertebral column and spinal cord can lead to alterations of its function and vertebral column destruction. Pathologies such as Parkinson's Disease, diabetic neuropathy, syringomyelia, and neural tube defects have been shown to cause neuroarthropathy as a long-term sequela [1,2]. Jean-Marie Charcot first described Charcot arthropathy in a patient in the 1800's.…”