rsjРоссийский хирургический журналRussian surgical journal3034-72703033-5604Фонд Алмазова10.18705/3034-7270-2025-1-4-88-99rsj-47Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯТактика хирургического лечения хронического остеомиелита позвоночника на фоне травматической плегии (спинальная нейроатропатия Шарко)Tactics of surgical treatment of chronic osteomyelitis of the spine on the background of traumatic plegia (Charcot spinal neuropathy)https://orcid.org/0000-0002-9186-6461ВишневскийА. А.VishnevskyA. A.

Вишневский Аркадий Анатольевич – д-р мед. наук, ведущий научный сотрудник, профессор

Санкт-Петербург 

Vishnevsky Arkadiy A. – Doctor of Medical Sciences, Leading Researcher, Professor

St. Petersburg 

vichnevsky@mail.ruhttps://orcid.org/0000-0002-9892-6260НаумовД. Г.NaumovD. G.

Наумов Денис Георгиевич – канд. мед. наук, заместитель директора по травматологии и ортопедии 

Санкт-Петербург 

Naumov Denis G. – Candidate of Medical Sciences, Deputy Director of Traumatology and Orthopedics

St. Petersburg 

dgnaumov1@gmail.comhttps://orcid.org/0000-0003-3187-1274БеляковМ. В.BelyakovM. V.

Беляков Михаил Викторович – канд. мед. наук 

Санкт-Петербург 

Belyakov Mikhail V. – Candidate of Medical Sciences 

St. Petersburg 

mm.shelkunov1881@yandex.ruhttps://orcid.org/0009-0008-7980-4699СовпенчукИ. А.SovpenchukI. A.

Совпенчук Игорь Алексеевич – врач травматолог-ортопед 

Санкт-Петербург 

Sovpenchuk Igor A. – orthopedic traumatologist

St. Petersburg 

kotdono@gmail.comСанкт-Петербургский научно-исследовательский институт фтизиопульмонологии Министерства здравоохранения Российской ФедерацииРоссияRussian Federation Healthcare Ministry Saint-Petersburg State Phthisiopulmonology Research InstituteRussian FederationСанкт-Петербургский научно-исследовательский институт фтизиопульмонологии Министерства здравоохранения Российской Федерации ; Санкт-Петербургский государственный университетРоссияRussian Federation Healthcare Ministry Saint-Petersburg State Phthisiopulmonology Research Institute ; Saint-Petersburg State UniversityRussian Federation202523122025148899Copyright © Вишневский А.А., Наумов Д.Г., Беляков М.В., Совпенчук И.А., 20262026Вишневский А.А., Наумов Д.Г., Беляков М.В., Совпенчук И.А.Vishnevsky A.A., Naumov D.G., Belyakov M.V., Sovpenchuk I.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsj.elpub.ru/jour/article/view/47

Спинальная нейроартропатия Шарко – редкое заболевание, которое обусловлено посттравматическими нарушениями проприорецепции и глубокой чувствительности. Проявляется формированием псевдоартрозов и нестабильности позвоночно-двигательных сегментов ниже места его повреждения. Цель исследования – изучить особенности клинического течения спондилитов на фоне спинальной нейроартропатии Шарко и оценить результаты их хирургического лечения. Дизайн – малая клиническая серия и обзор литературы. В исследование включены 10 клинических наблюдений пациентов со спинальной нейроартропатии Шарко, проходивших лечение в Санкт-Петербургском НИИ фтизиопульмонологии МЗ РФ с 2014 по 2024 гг. По результатам бактериологического и гистологического исследований пациенты разбиты на две группы. В группу А вошли четыре пациента с асептическим воспалением, а в группу Б – шесть пациентов с верифицированным гнойным воспалением, в посевах у этих пациентов в 66,7 % случаев (четыре пациента) выявлены популяции S. Epidermidis-1, S. aureus-1, E. coli-1, Prot. vulgaris-1. При своевременно проведенном хирургическом лечении большинство пациентов, особенно с неполной параплегией, имеют хороший ближайший прогноз. Однако в отдаленном периоде у 30 % пациентов проводятся реоперации из-за развития нестабильности позвонково-двигательного сегмента, формирования синдрома смежного уровня и\или прогрессирования воспалительного процесса в позвоночнике.

Charcot spinal neuroarthropathy is a rare disease that is caused by post-traumatic disorders of proprioception and deep sensitivity, and is manifested by the formation of pseudoarthrosis and instability of the spinal motor segments below the site of its damage. The aim of the study was to study the features of the clinical course and methods of surgical treatment of spondylitis on the background of Сharcot spinal neuroarthropathy. Design is a small clinical series and literature review. The study included 10 clinical observations of patients with Сharcot spinal neuroarthropathy who were treated at the St. Petersburg Research Institute of Phthisiopulmonology of the Ministry of Health of the Russian Federation from 2014 to 2024. According to the results of bacteriological and histological examinations, the patients were divided into two groups. Group A included four patients with aseptic inflammation, and group B included 6 patients with purulent inflammation verified by histological examination. In 66.7 % of cases (4 patients) populations of S. Epidermidis-1, S. aureus-1, E. coli.-1, Prot. vulgaris-1 were detected in the crops of these patients. With timely surgical treatment, most patients, especially those with incomplete paraplegia, have a good short-term prognosis, however, in the long term, 30 % of patients undergo re-surgery due to the development of instability of the vertebral-motor segment, the formation of an adjacent level syndrome and/or the progression of the inflammatory process in the spine

хронический остеомиелит позвоночникатравматическая плегия позвоночникалечениепрогнозchronic osteomyelitis of the spinetraumatic spinal plegiatreatmentprognosisReferencesCardenas DD, Hoffman JM, Kirshblum S, McKinley W. Etiology and incidence of rehospitalization after traumatic spinal cord injury: a multicenter analysis. Arch Phys Med Rehabil. 2004;85:1757. https://doi.org/10.1016/j.apmr.2004.03.016.Cardenas DD, Hoffman JM, Kirshblum S, McKinley W. Etiology and incidence of rehospitalization after traumatic spinal cord injury: a multicenter analysis. Arch Phys Med Rehabil. 2004;85:1757. https://doi.org/10.1016/j.apmr.2004.03.016.Savic G, Short DJ, Weitzenkamp D, et al. Hospital readmissions in people with chronic spinal cord injury. Spinal Cord. 2000;38:371. https://doi.org/10.1038/sj.sc.3101019.Savic G, Short DJ, Weitzenkamp D, et al. Hospital readmissions in people with chronic spinal cord injury. Spinal Cord. 2000;38:371. https://doi.org/10.1038/sj.sc.3101019.Lee D, Dahdaleh NS. Charcot spinal arthropathy. J Craniovertebral Junction Spine. 2018;9:9–19. https://doi.org/10.4103/jcvjs.JCVJS_130_17.Lee D, Dahdaleh NS. Charcot spinal arthropathy. J Craniovertebral Junction Spine. 2018;9:9–19. https://doi.org/10.4103/jcvjs.JCVJS_130_17.Ledbetter LN, Salzman KL, Sanders R, et al. Spinal neuroarthropathy: pathophysiology, clinical and imaging features, and differential diagnosis. Radiographics. 2016;36(3):783– 99. https://doi.org/10.1148/rg.2016150121.Ledbetter LN, Salzman KL, Sanders R, et al. Spinal neuroarthropathy: pathophysiology, clinical and imaging features, and differential diagnosis. Radiographics. 2016;36(3):783– 99. https://doi.org/10.1148/rg.2016150121.Aebli N, Pötzel T, Krebs J. Characteristics and surgical management of neuropathic (Charcot) spinal arthropathy after spinal cord injury. Spine J. 2014;14:884–891. https://doi.org/10.1016/j.spinee.2013.07.441.Aebli N, Pötzel T, Krebs J. Characteristics and surgical management of neuropathic (Charcot) spinal arthropathy after spinal cord injury. Spine J. 2014;14:884–891. https://doi.org/10.1016/j.spinee.2013.07.441.Vialle R, Mary P, Tassin J-L, et al. Charcot’s disease of the spine spine. Spine. 2005;30:315–322. https://doi.org/10.1097/01.brs.0000164283.01454.9f.Vialle R, Mary P, Tassin J-L, et al. Charcot’s disease of the spine spine. Spine. 2005;30:315–322. https://doi.org/10.1097/01.brs.0000164283.01454.9f.Morita M, Miyauchi A, Okuda S, et al. Charcot spinal disease after spinal cord injury. J Neurosurg Spine. 2008;9(5):419–426. https://doi.org/10.3171/SPI.2008.9.11.419.Morita M, Miyauchi A, Okuda S, et al. Charcot spinal disease after spinal cord injury. J Neurosurg Spine. 2008;9(5):419–426. https://doi.org/10.3171/SPI.2008.9.11.419.Barrey C, Massourides H, Cotton F, et al. Charcot spine: two new case reports and a systematic review of 109 clinical cases from the literature. Ann Phys Rehabil Med. 2010;53(3):200– 220. https://doi.org/10.1016/j.rehab.2009.11.008.Barrey C, Massourides H, Cotton F, et al. Charcot spine: two new case reports and a systematic review of 109 clinical cases from the literature. Ann Phys Rehabil Med. 2010;53(3):200– 220. https://doi.org/10.1016/j.rehab.2009.11.008.Boudabbous S, Paulin EN, Delattre BMA, et al. Spinal disorders mimicking infection. Insights Imaging. 2021;12:176. https://doi.org/10.1186/s13244-021-01103-5.Boudabbous S, Paulin EN, Delattre BMA, et al. Spinal disorders mimicking infection. Insights Imaging. 2021;12:176. https://doi.org/10.1186/s13244-021-01103-5.Lacout A, Lebreton C, Mompoint D, et al. CT and MRI of spinal neuroarthropathy. AJR Am J Roentgenol. 2009;193:505– 514. https://doi.org/10.2214/AJR.09.2268.Lacout A, Lebreton C, Mompoint D, et al. CT and MRI of spinal neuroarthropathy. AJR Am J Roentgenol. 2009;193:505– 514. https://doi.org/10.2214/AJR.09.2268.Wagner SC, Schweitzer ME, Morrison WB, et al. Can imaging findings help differentiate spinal neuropathic arthropathy from disk space infection? Initial experience. Radiology. 2000;214(3):693–699. https://doi.org/10.1148/radiology.214.3.r00mr16693.Wagner SC, Schweitzer ME, Morrison WB, et al. Can imaging findings help differentiate spinal neuropathic arthropathy from disk space infection? Initial experience. Radiology. 2000;214(3):693–699. https://doi.org/10.1148/radiology.214.3.r00mr16693.Pakarinen TK, Laine HJ, Mäenpää H, et al. Effect of immobilization, off-loading and zoledronic acid on bone mineral density in patients with acute Charcot neuroarthropathy: a prospective randomized trial. Foot Ankle Surg. 2013;19:121–124. https://doi.org/10.1016/j.fas.2012.12.007.Pakarinen TK, Laine HJ, Mäenpää H, et al. Effect of immobilization, off-loading and zoledronic acid on bone mineral density in patients with acute Charcot neuroarthropathy: a prospective randomized trial. Foot Ankle Surg. 2013;19:121–124. https://doi.org/10.1016/j.fas.2012.12.007.Suda Y, Shioda M, Kohno H, et al. Surgical treatment of Charcot spine. J Spinal Disord Tech. 2007;20:85–88. https://doi.org/10.1097/01.bsd.0000211245.29458.03.Suda Y, Shioda M, Kohno H, et al. Surgical treatment of Charcot spine. J Spinal Disord Tech. 2007;20:85–88. https://doi.org/10.1097/01.bsd.0000211245.29458.03.David KS, Agarwala AO, Rampersaud YR. Charcot arthropathy of the lumbar spine treated using one-staged posterior threecolumn shortening and fusion. Spine. 2010;35:657–662. https://doi.org/10.1097/BRS.0b013e3181e03577.David KS, Agarwala AO, Rampersaud YR. Charcot arthropathy of the lumbar spine treated using one-staged posterior threecolumn shortening and fusion. Spine. 2010;35:657–662. https://doi.org/10.1097/BRS.0b013e3181e03577.Moreau S, Lonjon G, Jameson R, et al. Do all Charcot spine require surgery? Orthop Traumatol Surg Res. 2014;100:779– 784. https://doi.org/10.1016/j.otsr.2014.05.021.Moreau S, Lonjon G, Jameson R, et al. Do all Charcot spine require surgery? Orthop Traumatol Surg Res. 2014;100:779– 784. https://doi.org/10.1016/j.otsr.2014.05.021.Urits I, Amgalan A, Jisrael J, et al. A comprehensive review of the treatment and management of Charcot spine. Ther Adv Musculoskelet Dis. 2020;12:1759720X20979497. https://doi.org/10.1177/1759720X20979497.Urits I, Amgalan A, Jisrael J, et al. A comprehensive review of the treatment and management of Charcot spine. Ther Adv Musculoskelet Dis. 2020;12:1759720X20979497. https://doi.org/10.1177/1759720X20979497.Solinsky R, Donovan JM, Kirshblum SC. Charcot spine following chronic spinal cord injury: an analysis of 201 published cases. Spinal Cord. 2019;57:85–90. https://doi.org/10.1038/s41393-018-0216-6.Solinsky R, Donovan JM, Kirshblum SC. Charcot spine following chronic spinal cord injury: an analysis of 201 published cases. Spinal Cord. 2019;57:85–90. https://doi.org/10.1038/s41393-018-0216-6.Von Glinski A, Frieler S, Elia CJ, et al. Surgical management of Charcot spinal arthropathy in the face of possible infection. Int J Spine Surg. 2021;15(4):752–62. https://doi.org/10.14444/8097.Von Glinski A, Frieler S, Elia CJ, et al. Surgical management of Charcot spinal arthropathy in the face of possible infection. Int J Spine Surg. 2021;15(4):752–62. https://doi.org/10.14444/8097.Lee Y-P, Farhan SA, Kiester PD, et al. Charcot disease of the spine. Contemp Spine Surg. 2020;21:1–5. https://doi.org/10.1097/01.CSS.0000652732.44002.e9.Lee Y-P, Farhan SA, Kiester PD, et al. Charcot disease of the spine. Contemp Spine Surg. 2020;21:1–5. https://doi.org/10.1097/01.CSS.0000652732.44002.e9.Yelamarthy K, Krishna P, Rustagi T, et al. Infected Charcot spine arthropathy. Spinal Cord Ser Cases. 2018;4:73. https://doi.org/10.1038/s41394-018-0111-6.Yelamarthy K, Krishna P, Rustagi T, et al. Infected Charcot spine arthropathy. Spinal Cord Ser Cases. 2018;4:73. https://doi.org/10.1038/s41394-018-0111-6.Pola E, Autore G, Formica VM, et al. New classification for the treatment of pyogenic spondylodiscitis: validation study on a population of 250 patients with a follow-up of 2 years. Eur Spine J. 2017;26(4):479–488. https://doi.org/10.1007/s00586-017-5043-5.Pola E, Autore G, Formica VM, et al. New classification for the treatment of pyogenic spondylodiscitis: validation study on a population of 250 patients with a follow-up of 2 years. Eur Spine J. 2017;26(4):479–488. https://doi.org/10.1007/s00586-017-5043-5.Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:71. https://doi.org/10.1136/bmj.n71.Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:71. https://doi.org/10.1136/bmj.n71.Larson SA, Burns PR. The pathogenesis of Charcot neuroarthropathy: current concepts. Diabet Foot Ankle. 2012;3. https://doi.org/10.3402/dfa.v3i0.12236.Larson SA, Burns PR. The pathogenesis of Charcot neuroarthropathy: current concepts. Diabet Foot Ankle. 2012;3. https://doi.org/10.3402/dfa.v3i0.12236.Tarukado K, Ueda Sh. Infected Charcot spine arthropathy following spinal cord injury. Spine Surg Relat Res. 2022;6(6):725–728. https://doi.org/10.22603/ssrr.2022-0078.Tarukado K, Ueda Sh. Infected Charcot spine arthropathy following spinal cord injury. Spine Surg Relat Res. 2022;6(6):725–728. https://doi.org/10.22603/ssrr.2022-0078.Ryu JH, Lee JS, Lim CR, et al. Cerebrospinal fluid-cutaneous fistula associated with post-traumatic Charcot spinal arthropathy: a case report and review of literature. BMC Musculoskeletal Disord. 2020;21:412. https://doi.org/10.1186/s12891-020-03451-7.Ryu JH, Lee JS, Lim CR, et al. Cerebrospinal fluid-cutaneous fistula associated with post-traumatic Charcot spinal arthropathy: a case report and review of literature. BMC Musculoskeletal Disord. 2020;21:412. https://doi.org/10.1186/s12891-020-03451-7.Allain J, Dufour T. Anterior lumbar fusion techniques: ALIF, OLIF, DLIF, LLIF, IXLIF. Orthop Traumatol Surg Res. 2020;106:149– 157. https://doi.org/10.1016/j.otsr.2019.05.024.Allain J, Dufour T. Anterior lumbar fusion techniques: ALIF, OLIF, DLIF, LLIF, IXLIF. Orthop Traumatol Surg Res. 2020;106:149– 157. https://doi.org/10.1016/j.otsr.2019.05.024.Arizumi F, Maruo, Kishima K, et al. Minimally invasive thoracic-lumbar stabilization surgery for infected Charcot spine arthropathy (ICSA) after spinal cord injury. Cureus. 2024;16(2):e55039.Arizumi F, Maruo, Kishima K, et al. Minimally invasive thoracic-lumbar stabilization surgery for infected Charcot spine arthropathy (ICSA) after spinal cord injury. Cureus. 2024;16(2):e55039.Kim TW, Seo EM, Hwang JT, Kwak BC. Charcot spine treated using a single staged posterolateral costotransversectomy approach in a patient with traumatic spinal cord injury. J Korean Neurosurg Soc. 2013;54,532–536. https://doi.org/10.3340/jkns.2013.54.6.532.Kim TW, Seo EM, Hwang JT, Kwak BC. Charcot spine treated using a single staged posterolateral costotransversectomy approach in a patient with traumatic spinal cord injury. J Korean Neurosurg Soc. 2013;54,532–536. https://doi.org/10.3340/jkns.2013.54.6.532.Cassidy RC, Shaffer WO. Charcot arthropathy because of congenital insensitivity to pain in an adult. Spine J. 2008;8(4):691–695. https://doi.org/10.1016/j.spinee.2007.04.005.Cassidy RC, Shaffer WO. Charcot arthropathy because of congenital insensitivity to pain in an adult. Spine J. 2008;8(4):691–695. https://doi.org/10.1016/j.spinee.2007.04.005.Grassner L, Geuther M, Mach O, et al. Charcot spinal arthropathy: an increasing long-term sequel after spinal cord injury with no straightforward management. Spinal Cord Ser Cases. 2015;1:15022. https://doi.org/10.1038/scsandc.2015.22Grassner L, Geuther M, Mach O, et al. Charcot spinal arthropathy: an increasing long-term sequel after spinal cord injury with no straightforward management. Spinal Cord Ser Cases. 2015;1:15022. https://doi.org/10.1038/scsandc.2015.22Haus BM, Hsu AR, Yim ES, et al. Long-term follow-up of the surgical management of neuropathic arthropathy of the spine. Spine J. 2010;10:e6–16. https://doi.org/10.1016/j.spinee.2010.03.030Haus BM, Hsu AR, Yim ES, et al. Long-term follow-up of the surgical management of neuropathic arthropathy of the spine. Spine J. 2010;10:e6–16. https://doi.org/10.1016/j.spinee.2010.03.030Lee D, Dahdaleh NS. Charcot spinal arthropathy. J Craniovertebral Junction Spine. 2018;9:9–19. https://doi.org/10.4103/jcvjs.JCVJS_130_17.Lee D, Dahdaleh NS. Charcot spinal arthropathy. J Craniovertebral Junction Spine. 2018;9:9–19. https://doi.org/10.4103/jcvjs.JCVJS_130_17.Shen FH, Qureshi R, Tyger R, et al. Use of the “dual construct” for the management of complex spinal reconstructions Spine J. 2018;18(3):482–490. https://doi.org/10.1016/j.spinee.2017.08.235Shen FH, Qureshi R, Tyger R, et al. Use of the “dual construct” for the management of complex spinal reconstructions Spine J. 2018;18(3):482–490. https://doi.org/10.1016/j.spinee.2017.08.235Zyck S, Toshkezi G, Pizzuti J, et al. Four-rod instrumentation for treatment of Charcot spinal arthropathy causing autonomic dysreflexia: case report and literature review. Cureus. 2016;8:1–9.Zyck S, Toshkezi G, Pizzuti J, et al. Four-rod instrumentation for treatment of Charcot spinal arthropathy causing autonomic dysreflexia: case report and literature review. Cureus. 2016;8:1–9.Fiechter М, Bratelj D, Jaszczuk P, et al. Multi-rod fixation in spinal neuroarthropathy: a novel surgical technique. J Spine Surg. 2023,30;9(2):176–185.Fiechter М, Bratelj D, Jaszczuk P, et al. Multi-rod fixation in spinal neuroarthropathy: a novel surgical technique. J Spine Surg. 2023,30;9(2):176–185.

The authors declare that there are no conflicts of interest present.