Surgical treatment of neuropathic spinal arthropathy.

Surgical treatment of neuropathic spinal arthropathy is traditionally associated with a high rate of complication. Ten patients were treated surgically using contemporary techniques of spinal instrumentation and fusion which included combined anterior and posterior procedures when appropriate. The etiology of the spinal arthropathy was fracture (8 patients) and tumor (2 patients). Mean postsurgical follow-up was 4 years. Solid arthrodesis was obtained in eight patients. Our recommendations for surgical treatment include (a) posterior segmental instrumentation and fusion for single level Charcot involvement, with bone grafting of the anterior single level defect accomplished through the posterolateral approach; (b) restoration of normal sagittal plane contour, with anterior first stage surgery recommended for rigid kyphosis or multiple level Charcot involvement; and (c) leaving no intercurrent unfused segments between new and old fusions in the area of neurologic deficit. Fusion to the pelvis is not always necessary but late arthropathy may develop between the fused segment and the pelvis.