Charcot Arthropathy in the Lumbar Spine: Case Report

Introduction: Charcot arthropathy of the spine is a process in which the stability of the spine is affected due to joint involvement, causing joint destruction, pain and deformity. The most frequently associated cause is trauma, conservative treatment is an option depending on the characteristics of each patient, and surgical treatment, if indicated, can represent a real challenge for the orthopedist due to the instrumentation techniques that are generally needed. Clinical case: A clinical case of a patient treated in the orthopedics and traumatology division of the ISSSTE Susulá hospital clinic is presented. A 57-year-old woman with a 15-year history of type 2 diabetes mellitus treated with metformin, the patient was diagnosed with Charcot arthropathy in the left foot with conservative treatment based on immobilization, after resolution of the condition, already in the consolidation stage. The patient is offered the possibility of opting for surgical treatment, which is rejected by the patient. In his follow-up consultation, he reported pain at the level of the lumbar spine that began approximately 2 years ago, referring pain at the level of the lower back, to the neurological examination with preserved reflexes at all levels, with a decrease in muscle mass as well as strength at level of the knee extensor muscles and also the ankle flexor, all bilaterally. AP and lateral radiographs of the lumbar spine demonstrate loss of intervertebral space between L2 and L3, as well as fusion between the vertebral bodies themselves. A biopsy is taken in which an infectious and tumor process is ruled out. The lumbar spine tomography shows data of loss of intervertebral space at the level of L2-L3 with fusion at the level of the same vertebral bodies without signs of instability, so the diagnosis of Charcot spine in the lumbar spine is made at the level of L2-L3 in consolidation stage. The diagnosis is integrated and conservative treatment is chosen, so the patient is sent to rehabilitation. Discussion: We present the case of a 57-year-old patient. It is important to remember that the diagnosis can be confused with an infectious or tumor process. It is reported that on average the time of diagnosis after the onset of neurological deterioration in this entity is 17.3 years. The current and ideal treatment is surgical instrumentation to provide support in patients who present instability, with single or multistage 360. Arthrodesis being the most used treatment that has demonstrated a reduction in spasticity and even a recovery of the neurological deficit prior to presenting joint Charcot spine in patients in whom there are no neurological alterations or signs of infection. Likewise, it has been shown that conservative treatment is the idea in patients with stable consolidations or who are already in the fusion stage without associated alterations, in our case the patient was diagnosed in the consolidation stage with stability, therefore conservative treatment was performed through radiological follow-up in consultation.