SHORTENING OSTEOTOMY FOR TREATMENT OF SPINAL NEUROARTHROPATHY. A CASE REPORT AND LITERATURE REVIEW.

Abstract

Background: We report on the surgical treatment of a case spinal neuroarthropathy, where surgical fusion of the pathological level was achieved by a shortening osteotomy and apposition of the adjacent vertebral bodies. Neuropathic (Charcot) arthropathy of the spine is relatively an uncommon problem. Spinal neuroarthropathy has been described to occur after traumatic paralysis as well as other causes of neuropathic arthropathy. Surgery has been recommended for the treatment of painful or unstable neuropathic joints of the spine. From the few cases that have been reported in the literature, surgical management included extensive debridement, bridging of the defect with autogenous graft as well as instrumentation to achieve an anterior and posterior fusion. To the knowledge of the authors, the technique of spine shortening and vertebral apposition was reported only once in the literature, however the patient had to be kept recumbent in a cast for six months. (1)

Methods: Literature review and a case of spinal neuroarthropathy successfully treated by a shortening osteotomy and instrumented arthrodesis is presented.

Results: Patient was allowed to mobilize in his wheelchair by the second week post operation with a support of a TLSO, which was used for five months. Roentgenograms and CT scan done at thirteen months showed good position of the spine and evidence of solid bone arthrodesis. This matched marked clinical improvement in the preoperative symptoms.

Conclusion: Treatment of a Charcot affection of the spine should be directed toward vertebral stabilization to eliminate the pathological effects and complications secondary to instability. Sound arthrodesis in our case could be achieved with resection of the affected level(s), shortening of the spine and good apposition of fresh bleeding bone surfaces. Careful attention to the demanding surgical technique is required. Yet, any fusion procedure poses additional stresses to the adjacent levels. So long term monitoring of the rehabilitation is mandatory to detect the possibility of developing secondary levels of Charcot joints below a previously successful fusion.