Two patients with Charcot disease of the spine who failed to respond to the usual conservative treatment of rest and braces have had relief of back pain after surgical arthrodesis of the involved area. Each of these patients had additional lower-extremity joint lesions which complicated the end result. Spine fusion was solid in both patients, after the usual length of time and postoperative management. Roentgenograms show arrest of the destructive and disintegrating processes of the vertebrae after surgical arthrodesis and solid fusion of the diseased portion. There was no evidence of further destruction in the five and seventeen years, respectively, that these patients were followed.
Not all patients with Charcot disease of the spine require surgery. The authors feel that fusion is indicated in patients with intractable pain, signs of marked instability of the spine, or nerve-root and spinal-cord irritation who have failed to respond to braces. The chance for solid fusion in these patients seems satisfactory.
With solid fusion, one can expect recovery from severe radiating pain, muscle weakness, paraplegia, and cessation of the destructive bone changes. In younger patients with an otherwise good life expectancy, it might be wise to perform this procedure as a prophylactic measure after a definite diagnosis of Charcot disease is made.
The results of only three other spine fusions for Charcot disease of the spine have been reported. In all patients, a satisfactory result was obtained.
Copyright 1959 by The Journal of Bone and Joint Surgery, Incorporated