Research ArticleLumbar Spine

Surgical Management of Charcot Spinal Arthropathy in the Face of Possible Infection

Alexander Von Glinski, Sven Frieler, Christopher J. Elia, Darius Ansari, Clifford Pierre, Basem Ishak, Ronen Blecher, Bilal Qutteineh, Sarah Strot, Rod J. Oskouian and Jens R. Chapman
International Journal of Spine Surgery August 2021, 15 (4) 752-762; DOI: https://doi.org/10.14444/8097

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Figures

  • Figure 1
    Figure 1

    Patient 2 (71F): Midthoracic (T4) spinal cord injury, unstable L5–S1 junction. (A) (left top) and (B) (right top) Anterior/posterior and lateral, (C) (left bottom) extension, and (D) (right bottom) flexion views.

  • Figure 2
    Figure 2

    Identification and exclusion of study cohort.

  • Figure 3
    Figure 3

    Patient 4: Second-stage surgery 21 days after polymethylmethacrylate strut insertion. One temporary rod broke caudally after transfer maneuver. Removal followed segmental instrumentation. Extensive aggressive debridement of spine and instrumentation tracks and completion L1–L3 vertebrectomies, pulsatile lavage, 9 L, remove antibiotic spacers. Anterior lumbar interbody fusion with expandable cage, Stryker AVS, and bone morphogenic protein (BMP) and allograft. Posterior spinal instrumentation and fusion T8 to ilium with quadruple-rod fixation and multiple crosslinks and posterolateral fusion, and posterior lamina fusion L4–S1, with BMP allograft.

  • Figure 4
    Figure 4

    Patient 2: Partial removal caudal end of Harrington rod, laminectomy, and epidural debridement, L5–S1. Posterior interbody fusion with bilateral expandable titanium cage with bone morphogenic protein (BMP) with local and allograft bone and posterior spinal instrumentation T10 to pelvis with quadruple-rod construct. L5–S1 fusion, posterolateral fusion and fusion to ilium using local bone and allograft BMP.

  • Figure 5
    Figure 5

    Distribution of spinal cord injury (SCI) and Charcot spinal arthropathy (CSA) incidence by vertebral level. Note CSA levels typically develop distal to level of SCI.

  • Figure 6
    Figure 6

    Patient 4: Extensive destructive Charcot arthropathy of L2 and L3 vertebral bodies and large paravertebral abscess. Wide decompressive laminectomies L1–L3, partial vertebrectomies L2 and L3, resection of abscess capsule, open reduction and internal fixation T11–L5, insertion polymethylmethacrylate strut graft (2 g of Simplex nontobramycin cement and 4 g vancomycin), 2 crosslinks.

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Surgical Management of Charcot Spinal Arthropathy in the Face of Possible Infection
Alexander Von Glinski, Sven Frieler, Christopher J. Elia, Darius Ansari, Clifford Pierre, Basem Ishak, Ronen Blecher, Bilal Qutteineh, Sarah Strot, Rod J. Oskouian, Jens R. Chapman
International Journal of Spine Surgery Aug 2021, 15 (4) 752-762; DOI: 10.14444/8097
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