1/29. Destructive hip disease complicating traumatic paraplegia.Recent progress in the management of spinal cord injury has provided longer survivals, and as a result the incidence of secondary bone and joint disorders has increased. Joint lesions due to syringomyelia complicating a cervical spinal cord injury are the most common of these disorders. We report a case of destructive hip disease 7 years after an injury responsible for complete paraplegia with sensory loss. The joint lesions were painless, and there was no local evidence of inflammation. hip radiographs disclosed atrophic osteoarthropathy with complete destruction of the femoral neck and head. This unusual case raises questions about the pathophysiology of neuropathic osteoarthropathy in paraplegics.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/29. tabes dorsalis with sudden onset of paraplegia.A case is presented of tabes dorsalis with spinal gumma producing collapse of the L5 vertebra followed by paraplegia.- - - - - - - - - - ranking = 0.5keywords = spinal (Clic here for more details about this article) |
3/29. Charcot joint of the spine, a cause of autonomic dysreflexia in spinal cord injured patients.STUDY DESIGN: Case report of two subjects. OBJECTIVE: Charcot joints of the spine as a cause of autonomic dysreflexia in spinal cord lesions. SETTING: Stoke Mandeville Hospital, UK. METHOD: Two patients with long standing spinal cord lesions developed symptoms of headaches and sweating associated with sitting up and transfers. In both cases no other cause was found to account for autonomic dysreflexia. RESULT: Charcot joints of the spine below the level of injury were demonstrated in both cases and symptoms resolved with prolonged bed rest. CONCLUSION: As care of spinally injured patients continues to improve, they live longer and lead a more active lifestyle, it is expected that the incidence and prevalence of Charcot's joints will increase. Therefore the knowledge and heightened awareness of this entity, early diagnosis and detection with plain x-rays for urinary surveillance, may reduce the morbidity in spinal cord injured patients.- - - - - - - - - - ranking = 4keywords = spinal (Clic here for more details about this article) |
4/29. Neuropathic arthropathy caused by arnold-chiari malformation with syringomyelia.We report a case of neuropathic arthropathy caused by arnold-chiari malformation with syringomyelia, with details of the clinical and radiologic aspects. The patient had pain and stiffness in his left upper limb. MRI of the left shoulder revealed neuropathic arthropathy. Upon examination, his left elbow also had the characteristic findings for neuropathic arthropathy. Examination of the spinal cord by MRI confirmed arnold-chiari malformation associated with syringomyelia. Neuropathic arthropathy requires evaluation of the spinal cord to assess for occult causal lesions.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
5/29. Late spinal dislocation after treatment of spinal arteriovenous malformation. A case of Charcot spinal arthropathy.Neuropathic arthropathy of the spine is a destructive condition of the spine which is secondary to a loss of the protective proprioceptive reflexes. In the majority of cases, it occurs in patients who have suffered from traumatic medullary lesions and is responsible for destruction of the vertebral bodies and considerable spinal deformity. We report a case of neurogenic lumbar arthropathy in a patient with a spinal arteriovenous malformation. This vascular lesion caused considerable disturbances of proprioception. The course was favorable with regard to the deformity after correction and fusion by posterior approach.- - - - - - - - - - ranking = 7keywords = spinal (Clic here for more details about this article) |
6/29. Orthopaedic features in the presentation of syringomyelia.The orthopaedic surgeon is often the first consultant to whom a patient with syringomyelia is referred. The disease is not as rare as he may suppose, but its early presenting features are very variable; if he relies solely on such familiar features as pes cavus and scoliosis, he may well miss the diagnosis. The commonest presenting symptom is pain in the head, neck, trunk or limbs; headache or neckache made worse by straining is particularly significant. A history of birth injury also may suggest the possibility of syringomyelia, especially if any spasticity subsequently worsens. Neurological features which may be diagnostic include nystagmus, dissociated sensory loss, muscle wasting, spasticity of the lower limbs or Charcot's joints. Radiographic features include erosion of the bodies of cervical vertebrae and widening of the spinal canal; if, at C5, the size of the canal exceeds that of the body by 6 millimetres in the adult, pathological dilatation is present. The presence of basilar invagination or other abnormalities of the foramen magnum, of spina bifida occulta and of scoliosis are further pointers. thermography is a useful way of showing asymmetrical sympathetic involvement in early cases. A greater awareness of the prevalence of syringomyelia may lead to earlier diagnosis and to early operation, which appears to hold out the best hope of arresting what is all too commonly a severely disabling and progressive condition.- - - - - - - - - - ranking = 0.5keywords = spinal (Clic here for more details about this article) |
7/29. Charcot arthropathy in relation to autonomic dysreflexia in spinal cord injury: case report and review of the literature.Charcot spinal arthropathy has been described as a late complication of spinal cord injury. In patients with these injuries in whom the spine below the level of injury is insensate, joint trauma can progress until spinal instability ensues. The authors describe the case of a 50-year-old man with complete C-8 tetraplegia who experienced a 4-month history of episodic severe headaches, profuse sweating over his face and arms, and episodic severe hypertension in addition to a "grinding" sensation in the lower back. Charcot arthropathy at the T11-12 levels with pathological mobility was demonstrated on neuroimaging. Intraoperatively, a complete spinal cord transection was identified. Anterior and posterior thoracolumbar fusion across the mobile segment resulted in complete amelioration of signs and symptoms of autonomic dysreflexia. This entity, a common condition in the setting of spinal cord injury, has many triggers. Definitive treatment is targeted at the removal of the underlying cause. As demonstrated here, Charcot spinal arthropathy can act as a powerful trigger for induction of autonomic dysreflexia. Treatment of the associated spinal instability resulted in eradication of all signs and symptoms of the dysreflexia.- - - - - - - - - - ranking = 5.5keywords = spinal (Clic here for more details about this article) |
8/29. Charcot's disease of the spine: diagnosis and treatment.STUDY DESIGN: Retrospective study. OBJECTIVE: To report nine cases of Charcot's joint of the spine, to clarify the difficulty in diagnosis and treatment, and to analyze the literature. SUMMARY OF BACKGROUND: Charcot's joint of the spine, also known as spinal neuropathic or neurogenic arthropathy, is a destructive condition that affects the intervertebral disc and the adjacent vertebral bodies. It is the result of a loss of joint protection mechanisms, generally secondary to a spinal cord lesion. We report a series of nine patients treated surgically. methods: Eight men and one woman suffering from paraplegia or tetraplegia were reviewed. The time interval between the neurologic disorder and the diagnosis of neuropathic spinal arthropathy was 10 to 36 years. The most frequent presenting symptom was an evolutive thoracolumbar kyphosis, sometimes associated with back pain or increased spasticity in the lower limbs. The neuropathic arthropathy involved the thoracic spine in four patients and the lumbar spine in four other patients. The remaining patient presented two arthropathies, one thoracic and one lumbosacral. A percutaneous vertebral biopsy was performed in five patients suspected to have an infection or a tumor. Treatment was always surgical. In eight cases, a circumferential fusion was performed in the area of the dislocated vertebral levels. The postoperative follow-up was from 3 years to 10 years. RESULTS: A solid and stable circumferential fusion of the spine was obtained in all patients. The functional status improved in all patients. Pain and sagittal imbalance were successfully treated. The increased spasticity observed at the initial examination improved in all patients who returned to the neurological deficit initially present before the onset of Charcot's arthropathy. CONCLUSIONS: The diagnosis of Charcot's arthropathy of the spine must be considered in paraplegic and tetraplegic patients with spinal deformity with bone destruction and vertebral dislocation in the absence of an infection or neoplastic disease. The treatment of a Charcot's spine is circumferential fusion and osteosynthesis. Monitoring by clinical and imaging examination must be continued, because multifocal vertebral lesions can occur in cases of extensive proprioceptive deficit.- - - - - - - - - - ranking = 2keywords = spinal (Clic here for more details about this article) |
9/29. Charcot spinal arthropathy in a paraplegic weight lifter: case report.STUDY DESIGN: A case report of aggressive multilevel Charcot spinal arthropathy treated with staged spinal instrumentation. OBJECTIVES: To report an unusual case of Charcot spinal arthropathy, given the rapidity of progression and extent of tissue destruction, and present the results of successful spinal instrumentation and stabilization. SUMMARY OF BACKGROUND DATA: Charcot spinal arthropathy in the long-standing paraplegic patient is more commonly seen in those who have undergone prior spinal surgery and is usually restricted to 2 spinal levels. methods: A 36-year-old amateur weight lifter with T6 complete paraplegia presented with lower thoracic back pain, a kyphotic deformity of the thoracolumbar region, and gross spinal instability on transferring. Imaging revealed extensive bony destruction from T10-T12 and complete absence of spinal tissue over the affected levels. Staged anterior and posterior spinal instrumentation from T3 to L4 was performed. RESULTS: Spinal stabilization was achieved, and the patient was pain free and able to resume light training at 6-month follow-up. CONCLUSIONS: We would advise a high index of suspicion of Charcot arthropathy in the active paraplegic patient presenting with back pain caudal to their sensory level. Staged spinal instrumentation is an effective treatment for multilevel Charcot spinal arthropathy.- - - - - - - - - - ranking = 8keywords = spinal (Clic here for more details about this article) |
10/29. Neuroarthropathy of the wrist in paraplegia: A case report.BACKGROUND/OBJECTIVE: Neuroarthropathy, also known as Charcot joint, is most commonly seen in the spine and other weight-bearing joints in individuals with spinal cord injury (SCI). It is rarely seen in the joints of the upper extremities because the pathophysiology of the neuroarthropathy is thought to be significant repetitive trauma such as with weight bearing in an insensate joint. methods: Case report of neuroarthropathy in the wrist of a 46-year-old man with a 30-year history of T4 paraplegia caused by ependymoma. RESULTS: The patient recently developed a nonpainful swelling in the left wrist, which had decreased sensation since the time of his initial SCI. Radiological evaluation showed marked degenerative changes consistent with neuroarthropathy. A magnetic resonance image of the spine showed spinal cord atrophy at the cervicothoracic junction. CONCLUSIONS: This case shows an unusual presentation of a neuroarthropathy in a wrist in an individual with functional paraplegia. Because the treatment options for neuroarthropathy in the upper extremity in individuals with SCI are limited, early diagnosis is crucial to implement conservative management before significant destruction of the joint occurs.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
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