Charcot Disease of the Spine: Diagnosis and Treatment

Abstract

or neurogenic spinal arthropathy, is a rare, slowly progressive degeneration of the spine. This phenomenon occurs in the setting of any prior condition leading to the loss of afferent innervation to the spine and central nervous system. The end result is that the normal protective sensation of the joints in the vertebral column is diminished. This then leads to the progressive degeneration of the spinal column. Jean-Martin Charcot first described a causal link between neurologic injury and progressive bone and joint damage in 1868. His theory was based on the destruction of certain peripheral joints that he observed in patients with tertiary syphilis. Charcot described this damage as “ataxic arthropathy.” The first case of Charcot spinal arthropathy was reported in 1884 by Kronig in a patient with tabes dorsalis secondary to tertiary syphilis. Historically, Charcot spinal arthropathy was most commonly reported in the setting of tertiary syphilis. Contemporary Charcot spine cases are more commonly seen in patients who have suffered traumatic spinal cord injuries. Charcot spinal arthropathy may also occur secondary to conditions that disrupt the sensory signaling pathways, such as syringomyelia, meningocele, myelomeningocele, diabetes mellitus, peripheral neuropathies, Parkinson disease, transverse myelitis, and other conditions. Repetitive external forces to the insensate vertebral column cause inflammation in the subchondral bone and articular cartilage. This inflammatory process stimulates facet destruction, intervertebral disc degeneration, and bone destruction. This ultimately leads to progressive deformity and gross spinal instability. Untreated, Charcot spinal arthropathy can result in significant morbidity due to continuous pain, loss of sitting tolerance, ascending neurologic dysfunction, infection, vascular injury, and even death. Early medical and surgical care is required once the diagnosis has been recognized.