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Charcot Arthropathy of the Lumbar Spine Treated Using One-Staged Posterior Three-Column Shortening and Fusion

David, Kenny Samuel, MS*; Agarwala, Amit Omprakash, MD; Rampersaud, Yoga Raja, MD, FRCSC*

doi: 10.1097/BRS.0b013e3181e03577
Case Reports
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Study Design. Case report.

Objective. We present a case of lumbar Charcot arthropathy successfully treated surgically using posterior 3-column resection, spinal shortening, and fusion.

Summary of Background Data. The operative treatment of Charcot arthropathy of the spine has conventionally been a combination of anterior and posterior surgery. The morbidity associated with these surgical procedures can be considerable. A posterior-only approach to the problem would avoid the additional morbidity associated with an anterior approach. We present a case of lumbar Charcot arthropathy with deformity treated successfully using such a procedure.

Methods. Discussion of the patient's clinical and radiologic history, the technical merits of the operative intervention and a review of the relevant background literature are presented.

Results. A multilevel, single-stage, posterior 3-column resection with primary shortening and instrumented fusion augmented with rhBMP2 in a multiply operated patient with deformity provided a optimal biologic and mechanical environment for healing of the Charcot arthropathy and improved the sagittal and coronal profile of the spine.

Conclusion. A single-stage, multilevel, posterior 3-column resection and primary shortening can be a useful surgical strategy in symptomatic patients with Charcot arthropathy of the spine.

We present a case of lumbar Charcot arthropathy successfully treated surgically using single-stage, multilevel posterior 3-column resection, spinal shortening and fusion augmented with bone morphogentic protein.

From the *University of Toronto, University Health Network, Toronto Western Hospital, Toronto, Canada; and †Panorama Orthopedics and Spine Center.

Acknowledgment date: May 14, 2009. Revision date: September 8, 2009. Acceptance date: September 11, 2009.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, and consultancies.

Y. R. R. is a consultant for Medtronic Sofamor Danek.

Address correspondence and reprint requests to: Yoga Raja Rampersaud, MD, FRCSC, Krembil Neuroscience Center, Spine Program, University Health Network, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada; E-mail: raja.rampersaud@uhn.on.ca.

© 2010 Lippincott Williams & Wilkins, Inc.