Surgical management of Charcot spinal arthropathy: a single-center retrospective series highlighting the evolution of management
Notice bibliographique
Résumé
OBJECT: Charcot spinal arthropathy (CSA) is an uncommon disorder that occurs in the setting of conditions with decreased protective sensation of the vertebral column, resulting in vertebral joint degeneration, pain, and deformity. Historically, CSA treatment has been fraught with high failure rates. Over time, the authors' institution has trended toward a CSA treatment paradigm of intralesional debridement, circumferential fusion, and four-rod lumbopelvic fixation. As such, the overall objectives of this study were to define the specific clinical characteristics of this rare condition and to determine whether the authors' treatment paradigm has decreased the incidence of revision due to hardware failure/presumed pseudarthrosis or the development of a new CSA over the course of the study and in comparison with historical controls. METHODS: The authors performed a retrospective review of the clinical and radiographic records for all patients with CSA treated by the Spine Service at the University of Washington between 1997 and 2009. RESULTS: Twenty-three patients with CSA were identified. The mean age at presentation was 43.1 years, and the mean latency between spinal cord injury and CSA diagnosis was 19.6 years. The mean follow-up was 33.1 months. Pain and progressive deformity were the major presenting symptoms. Concomitant infection was identified in 17% of patients. Patients with CSA were noted to have long initial fusion constructs spanning an average of 8.4 vertebral levels. Charcot spinal arthropathy did not occur above the level of neurological injury. The vast majority of CSA cases occurred caudally along the spinal axis, with 65% occurring within 1 level of the caudal end of the index fusion construct and 35% occurring even farther distally. Revision due to hardware failure or the development of a new CSA level occurred in 35% of patients. Rates of treatment failure requiring revision significantly decreased over the course of the study, with revision occurring in 6 (66%) of 9 patients who underwent surgery before 2002, in comparison with only 2 (14%) of 14 treated between 2002 and 2009. During a mean follow-up period of 34 months, no treatment revision occurred in the subgroup of 9 patients who underwent four-rod lumbopelvic fixation. CONCLUSIONS: This study represents the largest reported modern surgical series of CSA patients. While revision rates were initially high and comparable to previous reports, the authors' multimodal treatment paradigm, which includes the use of bone morphogenetic protein and four-rod lumbopelvic fixation, dramatically reduced the incidence of treatment failure requiring revision over the course of the study period and represents a significant improvement in the treatment of CSA.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».