Abstract
Introduction
Patients with complete spinal cord injury (SCI) may develop concurrent sequalae that interact and share symptoms; thus, a careful approach to diagnosis and management of new symptoms is crucial.
Case presentation
A patient with prior T4 complete SCI presented with progressive autonomic nervous system (ANS) dysfunction. The initial differential diagnosis included syringomyelia and lumbar Charcot arthropathy. He had comorbid heterotopic ossification (HO) of the left hip. Surprisingly, his autonomic symptoms resolved following resection of the HO. In hindsight, loss of motion through the hip caused by HO may have led to hinging through a previously asymptomatic lumbar Charcot joint, causing dysautonomia.
Discussion
ANS dysfunction is a disabling sequela of complete SCI and has a broad differential diagnosis. Hip immobility may be an indirect and overlooked cause due to the mechanical relationship between the hip and the lumbar spine.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Hoche G, Sanders LJ. On some arthropathies apparently related to a lesion of the brain or spinal cord, by Dr. J.-M. Charcot, January 1868. J Hist Neurosci. 1992;1:75–87.
Wirth CR, Jacobs RL, Rolander SD. Neuropathic spinal arthropathy. A review of the Charcot spine. Spine. 1980;5:558–67.
Gibson JL, Vuong SM, Bohinski RJ. Management of autonomic dysreflexia associated with Charcot spinal arthropathy in a patient with complete spinal cord injury: case report and review of the literature. Surg Neurol Int. 2018;9:113.
Ledbetter LN, Salzman KL, Sanders RK, Shah LM. Spinal neuroarthropathy: pathophysiology, clinical and imaging features, and differential diagnosis. Radiographics. 2016;36:783–99.
Karlsson AK. Autonomic dysfunction in spinal cord injury: clinical presentation of symptoms and signs. Prog Brain Res. 2006;152:1–8.
Krassioukov AV, Karlsson AK, Wecht JM, Wuermser LA, Mathias CJ, Marino RJ. Assessment of autonomic dysfunction following spinal cord injury: rationale for additions to International Standards for Neurological Assessment. J Rehabil Res Dev. 2007;44:103–12.
Aebli N, Potzel T, Krebs J. Characteristics and surgical management of neuropathic (Charcot) spinal arthropathy after spinal cord injury. Spine J. 2014;14:884–91.
Selmi F, Frankel HL, Kumaraguru AP, Apostopoulos V. Charcot joint of the spine, a cause of autonomic dysreflexia in spinal cord injured patients. Spinal Cord. 2002;40:481–3.
Moreau S, Lonjon G, Jameson R, Judet T, Garreau de Loubresse C. Do all Charcot spine require surgery? Orthop Traumatol Surg Res. 2014;100:779–84.
Solinsky R, Donovan JM, Kirshblum SC. Charcot Spine following chronic spinal cord injury: an analysis of 201 published cases. Spinal Cord. 2019;57:85–90.
Lee D, Dahdaleh NS. Charcot spinal arthropathy. J Craniovertebral Junction Spine. 2018;9:9–19.
Brown CW, Jones B, Donaldson DH, Akmakjian J, Brugman JL. Neuropathic (Charcot) arthropathy of the spine after traumatic spinal paraplegia. Spine. 1992;17 Suppl 6:S103–8.
Hong J, Sanfilippo JA, Rihn J, Fernandez C, Winegar CD, Friel B, et al. Complications in the management of Charcot spinal arthropathy. J Neurosurg Spine. 2009;11:365–8.
Vavken P, Castellani L, Sculco TP. Prophylaxis of heterotopic ossification of the hip: systematic review and meta-analysis. Clin Orthop Relat Res. 2009;467:3283–9.
Cai L, Wang Z, Luo X, She W, Zhang H. Optimal strategies for the prevention of heterotopic ossification after total hip arthroplasty: a network meta-analysis. Int J Surg. 2019;62:74–85.
Bickelhaupt B, Richard M, Trbovich M. Advanced hip osteoarthritis causing autonomic dysreflexia and severe spasticity in a patient with spinal cord injury: a case report. PMR. 2017;9:1047–50.
Kriz J, Andel R, Hakova R. Delayed diagnosis of an unsuspected pelvic fracture in a patient with tetraplegia. J Spinal Cord Med. 2014;37:425–8.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare no conflict of interest.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Fatemi, P., Prolo, L.M., Giori, N.J. et al. Resection of hip heterotrophic ossification leads to resolution of autonomic nervous system dysfunction in a patient with spinal Charcot arthropathy: a case report. Spinal Cord Ser Cases 6, 41 (2020). https://doi.org/10.1038/s41394-020-0286-5
Received:
Revised:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41394-020-0286-5
