Charcot Spine in a Patient With Diabetes Mellitus

Abstract not available. Introduction provided instead.

Neuropathic arthropathy is a chronic progressive destructive disorder affecting one or more of the peripheral or axial articulations. The pathophysiology is a disturbance in the normal sensory (pain or proprioceptive) innervation of the joints.¹ The etiology of neuropathic arthropathy has been controversial since Charcot’s description in 1868. According to the neurotraumatic theory, which is the most widely accepted, abnormal sensory innervation to a joint will result in rapid joint destruction because of minor traumatic events.² Another theory is the neurovascular theory, which assumes that neurologic changes produced by an underlying medical disorder result in a hypervascular region in the subchondral bone that is characterized by increased osteoclastic resorption and osteoporosis. This state leads to pathologic microfractures and eventual subchondral collapse, followed by joint destruction.³

Neuropathic spine historically has been related to syphilis.⁴ Recently, syringomyelia, diabetes mellitus, congenital insensitivity to pain, and spinal cord injuries have been identified as predisposing factors. The thoracolumbar junction and lumbar spine are the areas most often affected. Neuropathic joints secondary to syringomyelia most commonly affect upper extremities, with the majority being monoarticular, involving the shoulder and less commonly the elbow.⁵ There are several case reports of Charcot spinal arthropathy after traumatic paraplegia.^6-12 Our review of the literature showed no reports of Charcot spinal arthropathy secondary to diabetes.