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Do all Charcot Spine require surgery? - 23/09/14

Doi : 10.1016/j.otsr.2014.05.021 
S. Moreau , G. Lonjon, R. Jameson, T. Judet, C. Garreau de Loubresse
 Hospital Raymond-Poincaré, Orthopedic Surgery Department, 104, boulevard Raymond-Poincaré, 92380 Garches, France 

Corresponding author. 73, rue Carnot, 92300 Levallois-Perret, France. Tel.: +33 6 82 32 73 20.

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En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Tuesday 23 September 2014
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Abstract

Introduction

Spinal neuroarthropathy (SNA), also called “Charcot spine”, is very uncommon disease of unknown etiology. Kronig first reported this pathology in 1884 on a patient with Tabes dorsalis (also known as syphilitic myelopathy). As syphilis tends to disappear in developed countries, spinal cord lesion is the most frequent etiology of SNA.

Objectives

To describe clinical and radiographic results in 12 patients suffering from spinal neuroarthropathy (SNA).

Methods

Twelve patients diagnosed with SNA were included in the study. All patients were wheelchair users. The average delay between the neurological disease and the diagnosis of SNA was 18years. All patients were initially treated conservatively. Surgery was only indicated in persistent symptomatic or instable cases, and for infected SNA. Surgery was a circumferential arthrodesis.

Results

From 12 patients, with a median follow-up of 4years, five patients were operated on and 7 patients were still conservatively treated. Two patients with back pain and evolutive destruction were declined for surgery. One suffered of bilateral hip ankylosis and extensive spinal surgery would have confined him to bed, and one due to an evolutive bedsore. One patient improved with a complete regression of back pain.

Conclusion

Nowadays, surgical treatment is recommended with an extensive and circumferential fusion, in order to prevent relapses. Good radiographic outcome is reported but functional results have not been studied. Natural evolution of SNA remains unknown but can be less disabling than surgery. This pathologic mobility can contribute to patient's autonomy and can therefore be considered as opportune. Conservative therapy can be considered for SNA.

Level of evidence

Level IV.

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Keywords : Charcot spine, Neuroarthropathy, Spinal neuroarthropathy, Axial neuroarthropathy, Conservative treatment


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© 2014  Publicado por Elsevier Masson SAS.
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