Long-term follow-up of the surgical management of neuropathic arthropathy of the spine

What is this thing called pain?

“…2), or loss-of-function mutations in the neurotrophic tyrosine kinase receptor TrkA and nerve growth factor (hereditary sensory and autonomic neuropathy type IV) typically result in self mutilation, bone fractures, multiple scars, joint deformities, amputations, and early death, underscoring the important protective role of nociceptive pain (3). The importance of preserving nociceptive pain is also revealed when peripheral neuropathy leads to a sensory denervation of joints, resulting in Charcot neuro-osteoarthropathy, with severe deformities due to joints damaged because of a lack of pain sensitivity (4,5). Nociceptive pain is, therefore, a pain essential for maintaining bodily integrity.…”

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

“…After the spine was fused to the sacrum or pelvis, the patient lost the capacity to perform activities of daily living. This case demonstrates that fusion to the sacrum or pelvis in the setting of limited hip range of motion can lead to a significant loss of function9). Although in most cases it is preferable to extend the fusion to the sacrum or pelvis, treatment should therefore be individualized.…”

“…Hans et al9) suggest that patients whose Charcot spine is fused to the lumbar spine have a higher long term risk of developing a second Charcot joint than those patients whose were fused to the sacrum or pelvis. An additional advantage of fusion to the pelvis is that it may be lead to a higher fusion rate.…”

“…An additional advantage of fusion to the pelvis is that it may be lead to a higher fusion rate. Therefore, in patients with Charcot involvement of the lumbar spine, extensive fusion to the pelvis was recommended9). But, Morita et al reported the limitation of extensive fusion to the pelvis with the case of a patient who could no longer perform self catherization after surgery, due to post-arthrodesis spinal ankylosis13).…”

“…Historically, the treatment of Charcot spine was conservative because surgical treatment had poor outcomes9,10). Recent advancements in instrumentation have facilitated the successful treatment of Charcot spine with surgical management.…”