Hospital Raymond Poincaré, Orthopedic Surgery Department, 104, bd Raymond Poincaré, 92380 Garches, France.
Eur Spine J. 2010 Jul;19 Suppl 2(Suppl 2):S108-13. doi: 10.1007/s00586-009-1131-5. Epub 2009 Aug 26.
Since the rarefaction of neurosyphilis, axial neuroarthropathy is mostly secondary to spinal cord pathologies. Peripheral manifestations of neuroarthropathy resulting from Guillain-Barré syndrome have already been reported but to our knowledge, this is the first case of a patient diagnosed with axial involvement. After the acute phase, a 47-year-old woman suffered of paraparesia with a partial loss of sensibility under the tenth thoracic vertebra. As a consequence, she developed first of all neuroarthropathy of both knees and few years later, a spinal involvement was discovered. Multiple surgeries of both knees and of the spine were required, due to non-union, relapse, and infection. Natural evolution of Charcot spine remains unknown. Surgical treatment is recommended but even with circumferential fusion, failures do frequently occur. This observation allows us to report an original case and to discuss the etiology of axial neuroarthropathy, the classical radiographic findings, and the inherent difficulties of its treatment.
自从神经梅毒变得罕见以来,轴索性神经关节病大多继发于脊髓病变。吉兰-巴雷综合征引起的神经关节病的外周表现已有报道,但据我们所知,这是首例诊断为轴索性受累的病例。在急性期过后,一名 47 岁女性出现第十胸椎以下部分感觉丧失的截瘫。因此,她首先患上了双膝神经关节病,几年后发现了脊柱受累。由于不愈合、复发和感染,需要对双膝和脊柱进行多次手术。查科氏脊椎的自然演变尚不清楚。建议进行手术治疗,但即使进行了环形融合,也经常会出现失败。该观察结果使我们能够报告一个原始病例,并讨论轴索性神经关节病的病因、典型的影像学发现以及其治疗所固有的困难。