# A Case of Charcot Spine Arthropathy at the Lumbosacral Level in a Patient With Ankylosis of the Spine

## TL;DR

This paper describes a rare case of Charcot spine arthropathy at the lumbosacral level in a patient with spinal ankylosis and the surgical interventions used to manage it.

## Contribution

The paper presents a novel surgical approach combining debridement, antibiotic cement, and transdiscal screws for a complex Charcot spine case with ankylosis.

## Key findings

- Debridement via a posterior approach and antibiotic-containing cement helped manage infection and prepare for subsequent surgery.
- Transdiscal screws and bone grafting improved spinal stability despite ankylosis.
- The patient regained independent sitting and movement despite a kyphotic alignment.

## Abstract

Charcot spinal arthropathy, a rare refractory progressive disease, is characterized by symptoms such as pain, deformity, and neurological impairment, which can significantly reduce functional ability, quality of life, and life expectancy. We report a case of Charcot spine at the L5/S1 level with long segment ankylosis to the L5 vertebra. We first performed thorough debridement via a posterior approach. We used antibiotic-containing cement as a spacer to fill the dead space, facilitating the second surgery approach. In the second surgery, transdiscal screws, which have a low profile and strong force, were used as anchors, and bulk bone harvested from both iliac bones was grafted to the intervertebral space. The lumbosacral alignment was kyphotic, and the patient could sit and move independently. Disimpaction was impossible, and a stoma had to be created.