Gibson Justin L, Vuong Shawn M, Bohinski Robert J
Department of Neurosurgery, University of Cincinnati College of Medicine, and Mayfield Clinic, Cincinnati, Ohio, USA.
Surg Neurol Int. 2018 May 29;9:113. doi: 10.4103/sni.sni_287_17. eCollection 2018.
Charcot spinal arthropathy (CSA) clearly represents a challenge in long-term spinal cord injury patients, one that can have extremely uncomfortable and potentially lethal outcomes if not managed properly.
A 66-year-old man with a history of complete C7 quadriplegia presented with new-onset autonomic dysreflexia that resulted from Charcot spinal arthropathy (CSA). Pathologic instability, in the atypical site of the mid-thoracic spine, spanning from the T8-T9 vertebral levels was appreciated on physical exam as an audible, palpable, and visible dynamic kyphosis; kyphosis was later confirmed on neuroimaging. Based on the CSA severity and sequelae, the patient underwent bilateral decompression laminectomy with lateral extracavitary arthrodesis and posterior instrumentation. Symptoms dramatically improved and at 1-year follow-up, dynamic thoracic kyphosis and most symptoms of autonomic dysreflexia had resolved.
Based on our case and published reports, vigilant imaging and thorough physical examination in long-standing spinal cord injury could help early diagnosis and treatment of CSA, theoretically preventing development of cord atrophy and subsequent long-term sequelae. Surgical correction rather than bracing may be recommended in patients who have complete injury at or above T6 in patients with symptoms of autonomic dysreflexia associated with CSA confirmed on neuroimaging.
夏科氏脊柱关节病（CSA）显然是长期脊髓损伤患者面临的一项挑战，如果处理不当，可能会产生极其不适且有潜在致命风险的后果。
一名66岁有C7完全性四肢瘫痪病史的男性患者，因夏科氏脊柱关节病（CSA）出现新发自主神经反射异常。体格检查发现，在胸椎中部非典型部位（T8 - T9椎体水平）存在病理性不稳定，表现为可闻及、可触及且可见的动态脊柱后凸；随后神经影像学检查证实了脊柱后凸。根据CSA的严重程度和后遗症情况，该患者接受了双侧减压椎板切除术、外侧腔外关节融合术及后路内固定术。症状显著改善，在1年的随访中，动态胸椎后凸及大多数自主神经反射异常症状均已消失。
根据我们的病例及已发表的报告，对长期脊髓损伤患者进行密切的影像学检查和全面的体格检查有助于CSA的早期诊断和治疗，理论上可预防脊髓萎缩及后续长期后遗症的发生。对于神经影像学检查证实患有与CSA相关的自主神经反射异常症状、T6及以上节段完全损伤的患者，可能建议采取手术矫正而非支具治疗。
