Abstract
Study design
Analysis of published cases
Objectives
To identify and describe symptoms, radiologic findings, treatment strategies, and reoccurrence of Charcot spine in individuals with spinal cord injury (SCI).
Methods
This analysis included all English articles published prior to October 2017, describing Charcot spine after SCI as identified by multiple reviewers. Articles were excluded if Charcot spine was attributed to alternative conditions. Individual level data were available for 94% of reported cases. Outcomes included demographic factors, injury characteristics, clinical presentation, radiologic findings, management, and reoccurrence.
Results
Fifty included papers described 201 individuals with SCI who developed Charcot spine. 86% of individuals had paraplegia and 93% of individuals had a neurologically complete injury. Mean length of initial spinal fusion spanned 7.7 vertebral bodies (SD = 3.9). The most common presenting symptoms were back pain (56%), spinal deformity (48%), and crepitus (34%). Vertebral body destruction (83%), osteophytes (61%), and endplate destruction (57%) were commonly reported on radiographs. Reoccurrence of Charcot spine was described in 19% of cases after initial treatment.
Conclusion
Charcot spine after SCI commonly presents with low back pain and radiologic evidence of vertebral body destruction. Cases have been described more often in individuals with paraplegia and neurologically complete injuries. Surgical management is often pursued. A high rate of reoccurrence of Charcot spine in individuals with SCI after initial treatment has been reported.
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Acknowledgements
We would like to especially thank Dr. Jörg Krebs for his help in providing deidentified individual data from pertinent aggregate Charcot spine case series.
Author contributions
RS was responsible for designing the review protocol, data extraction and analysis, interpreting results, and manuscript preparation. JMD was responsible for designing the review protocol, data verification, interpreting results, and manuscript preparation. SCK was responsible for designing the review protocol, interpreting results, and manuscript preparation.
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Solinsky, R., Donovan, J.M. & Kirshblum, S.C. Charcot Spine following chronic spinal cord injury: an analysis of 201 published cases. Spinal Cord 57, 85–90 (2019). https://doi.org/10.1038/s41393-018-0216-6
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DOI: https://doi.org/10.1038/s41393-018-0216-6
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