Charcot Arthropathy of the Lumbosacral Spine Mimicking a Vertebral Tumor after Spinal Cord Injury
A 38-year-old man was admitted to our department with a one-month history of back pain radiating from the right flank and abdomen that had recently worsened. He had developed quadriplegia after spinal cord injury at C5-6 (). For last twenty years previously, he had been in bed ridden state. He had also experienced intermittent back pain for 10 years. The patient presented at our institute to check a lumbosacral osteolytic mass found by computed tomography (CT) at another institute during an investigation of growing back pain. Clinical examination showed a complete, flaccid, and areflexic paralysis of both lower limbs, with no sensation below T2. The patient had limitations of motion with no significant contractures at the right hip, and no palpable masses, fluid collections, or appreciable lymphadenopathy. Laboratory analysis revealed no signs of a spinal infection.\nPlain radiography revealed erosion and destruction of L5 and the sacral vertebral body and the presence of paravertebral hypertrophic ossification with a pseudotumoral appearance around the L5-S1 joint (). A three dimensional CT scan highlighted the severity of the intervertebral dislocation in the lying position (), and magnetic resonance imaging (MRI) showed peripheral and paravertebral gadolinium uptake by the osteolytic lesion at L5 and S1 vertebrae ().\nIn view of these radiological features, the possibility of a chronic infection or a cancerous process was envisaged, and this prompted us to perform a vertebral needle biopsy. Cultures of central/disc liquid samples were negative, and histological findings revealed extensive fibrotic change but no evidence of an infective or neoplastic process. Based on clinical history, laboratory finding, and histologic features the lesion was consistent with CSA.\nIn terms of therapeutic options, the extensive spinal ankylosis and widespread para-osteoarthropathy around hips meant that stabilization surgery would probably have resulted in a poor functional outcome. Moreover, the patient refused a surgery because of the absence of malignancy. An external support with a body jacket molded for sitting was also suggested but the patient refused. Hence, we were only able to implement regular clinical and radiological monitoring. During follow-up no specific changes were observed after discharge.