Charcot spine: two new case reports and a systematic review of 109 clinical cases from the literature.

OBJECTIVE The goal of the present work was to report two new clinical cases on Charcot spinal arthropathy (Charcot spine) and to identify and review all cases reported in the literature since 1978. METHOD In parallel with a description of the clinical and radiological features of two new cases, we performed a detailed literature review after searching the PubMed and Pascal databases with the following keywords "Charcot spine", "Charcot spinal arthropathy" and "neuropathic arthropathy of the spine". RESULTS We identified 36 publications comprising a total of 109 cases of Charcot spine. Charcot spinal arthropathy generally occurs as a late complication of traumatic spine injury (17 years afterwards, on average) and predominantly affects the thoracolumbar junction. The main symptoms are pain, spinal deformity, a change in neurological status and the presence of an audible cracking noise during movement. The radiological features combine major disc and vertebral destruction associated with hypertrophic bone formation. The therapeutic indications must be discussed on a case-by-case basis, depending on the patient's neurological and general status. CONCLUSIONS Our review emphasizes the value of regular, systematic, long-term radiological and clinical monitoring of the injured spine, in order to detect this rare but probably under-diagnosed complication.