Neuropathic (Charcot) arthopathy of spine, knee and feet

Case contributed by Dr Yuan Ling

Presentation

Progressive kyphosis, knee and foot deformity.

Patient Data

Age: 75 years
Gender: Female

Reference is made to the CT study performed earlier in the day.  Thoracic kyphosis with varying degrees of ankylosis of the vertebral bodies and facet joints, most pronounced from T11 to L2. There is increased T10-11 disc space and facet joint space compared to other levels, with prominent fluid and cystic change within the intervertebral disc extending into the surrounding paravertebral tissues.  Dependent low signal is seen within many of the cysts corresponding to hyper dense material seen on today's CT study consistent with calcium debris. There is marrow edema within the adjacent vertebral bodies with moderately low T1 signal.  Despite the prominent cyst formation/fluid, there is no surrounding inflammation of the para vertebral fat or epidural fat.  Minimal narrowing of the spinal canal at this level with normal cord contour and cord signal is maintained.  High signal within the L3-4 intervertebral disc corresponds to disc vacuum phenomenon on the CT.

Comment:
The appearances at the T10-11 level are most in keeping with a Charcot joint (spinal neuroarthropathy) with this level being the susceptible site of hypermobility due to partial spinal ankylosis above and below. Infection is considered unlikely, although secondary infection is difficult to exclude. 

I note that the right knee also has an advanced neuropathic arthropathy appearance. Presumably the patient has a history of diabetic or other neuropathy? 

Mid thoracic anylosis and kyphosis. At either end of this segment, the intervertebral disc spaces are narrowed, with vacuum phenomenon at the inferior level. Vertebrae show mixed destructive and proliferative changes - endplate erosions with sclerosis and marginal osteophytosis; facet joint destruction with sclerosis and hypertrophy.

Severe destruction of the articular surfaces, with subchondral sclerosis and cyst formation. Marked erosion and remodelling of the patella. Disorganization and dislocation of the joint, with ossific debris in a large effusion.

X-ray

Bilateral foot

Extensive midfoot joint destruction and disorganization, with associated bony degenerative and proliferative changes in keeping with Charcot neuroarthropathy. The left navicula is markedly collapsed and sclerotic.

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Case information

rID: 69285
Published: 14th Jul 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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