Infected Charcot spine

Abstract

Study design: Case report of an infected Charcot spine following spinal cord injury. Objective: To describe this very rare pathological condition and the results of surgical treatment. Setting: A department of orthopaedic surgery in Japan. Methods: A 44-year-old man presented with a destructive lesion in the lumbo-sacral spine and a fistula in his back. Anterior bone graft, percutaneous external spinal fixation, and suction/ irrigation of the wound were performed. After 4 months, posterior spinal instrumentation surgery was carried out. Results: Primary closure of the fistula and complete bone fusion was achieved after the operation. Conclusion: Infection of a Charcot spine, although a rare clinical entity, should be considered as a diagnostic possibility in the spinal cord-injured patients. External spinal fixation is a useful method for the unstable spinal lesion with infection.Spinal Cord (2005) 43, 256-259.

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

“…MR findings are similar to those on CT, with better delineation and characterization of the soft tissue mass15-18).…”

“…The debridement is best performed via an anterior approach13). In cases with mild bony involvement, a posterior only approach may be effective5,18). However, in more advanced disease, most surgical strategies have involved anterior approaches to the spine, excision of diseased segments followed by anterior reconstruction, followed by supplemental posterior instrumentation via a separate approach15,18).…”

“…Unfortunately, the previous reports of two-stage procedures for Charcot spine have not included any details of operative time or intraoperative blood loss to enable a comparative analysis of anterior and posterior versus posterior approach alone17,18).…”

Infected charcot spine arthropathy

“…The largest documented case series on CSA by Jacobs et al, and Aebli et al, did not provide the details of their infected CSA cases [4,9]. We did, however, find case reports documenting the management of infected CSA (Table 3) [7,[10][11][12]. The source of infection in CSA is commonly through a fistulous tract or an infected decubitus but can also be hematogenous [7].…”

Charcot spinal arthropathy: an increasing long-term sequel after spinal cord injury with no straightforward management

“…It is challenging to discriminate between spondylodiscitis and a superinfected Charcot spine if the detailed patient history is not present. 20,21 Furthermore, patients suffering from recurrent infections (for example, urinary tract infections) are more likely to develop spinal infections. 4 A needle biopsy-ideally before the initiation of empiric antibiotic treatment-should be centered in the disc space to help in the distinction.…”