1216 - Charcot Spinal Arthropathy and Bowel Pattern Change: A Case Report

Case Diagnosis: Traumatic spinal cord injury (SCI) can be complicated by Charcot spinal arthropathy. Charcot spinal arthropathy, also known as spinal neuroarthropathy or Charcot spine, is a rare disease. Though etiology is unknown, Charcot spine is a slow, progressive degeneration of the vertebral joints in the setting of reduced afferent innervation. Due to the largely asymptomatic evolution of disease, diagnosis is typically at an advanced stage of bone destruction.

Case Description: A 54-year-old male with history of T9-T10 level spinal cord transection, diagnosed as an AIS A paraplegic, approached his physiatrist with acute increase in neuropathic back pain along with bowel pattern changes that began 2 years prior. Patient required digital evacuation instead of his suppository routine he had been doing for 9 years since onset of SCI. He felt back instability and neuropathic pain, along with abdominal bloating and worsening difficulty evacuating bowel. Patient denied history of diabetes, spasticity or fever. CT showed gross destruction of L3-L4 vertebral bodies. MRI showed 1) extensive osteolysis of L3-L4 with a large multiloculated fluid collection, raising concern for osteomyelitis; and 2) severe resorption of the central portions of L3 and L4 vertebral bodies. Bone biopsy showed fibrocartilage bone with extensive fibrosis and reactive synovium. Fluid collection was negative for bacterial infection or malignant cells. Diagnosis of Charcot spine was made.

Discussions: Post-initial SCI, ongoing spinal compression and concomitant symptom progression may result in different anatomic features being affected. Bowel pattern changes may be one of those features, therefore should be documented to understand the prevalence and its role in development of Charcot spinal arthropathy.

Conclusions: This case demonstrates the significance of documenting, recognizing and publishing the proportion of SCI patients who experience changes in bowel pattern years after SCI onset, as a sign for underlying complications in SCI and understanding its role in Charcot spinal arthropathy.