Abstract
In patients with Charcot spine, a loss of normal feedback response from the insensate
spine results in spinal neuropathy. Increasing deformity, which can manifest as sitting
imbalance, crepitus, or increased back pain, can result. We present the case of a
patient with a high-thoracic spinal cord injury (SCI) who subsequently developed a
Charcot joint at the T10-11 level that resulted in a dramatic increase in previously
controlled spasticity after fracture of an existing baclofen catheter. The 68-year-old
man with T4 paraplegia presented with increasing baclofen requirements and radiographic
evidence of fracture of the intrathecal baclofen catheter with an associated Charcot
joint with extensive bony destruction. The neuropathic spinal arthropathy caused mechanical
baclofen catheter malfunction and resulting increased spasticity. The patient was
found to have transected both his spinal cord and the baclofen catheter. Treatment
consisted of removal of the catheter and stabilization with long-segment instrumentation
and fusion from T6 to L2. Follow-up radiographs obtained a year and a half after surgery
showed no evidence of hardware failure or significant malalignment. The patient has
experienced resolution of symptoms and does not require oral or intrathecal baclofen.
This is the only reported case of a Charcot spine causing intrathecal catheter fracture,
leading to increased spasticity. This noteworthy case suggests that late spinal instability
should be considered in the setting of SCI and increased spasticity.
Keywords
List of abbreviations:
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Article info
Publication history
Published online: November 24, 2014
Footnotes
Disclosures: Ray reports personal fees from Dupuy and Ulrich, and grants from the National Institutes of Health outside the submitted work. Dailey reports personal fees and grants from Biomet, personal fees from AO North America, and personal fees from Stryker outside the submitted work. The other authors have nothing to disclose.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
