Three cases of Charcot spinal arthropathy in long-standing (greater than 20 years) paraplegia are presented. In this group of patients with other known chronic infections, the differential diagnosis strongly favored osteomyelitis. Scanning techniques including technetium 99, indium 111, and computed tomography (CT) were used in the extensive work-up and were helpful, although not diagnostic. Closed needle and, in two cases, open biopsies eventually confirmed the diagnosis. The possible occurrence of this neuroarthropathy long after the onset of nonprogressive paraplegia should be kept in mind by those treating spinal cord injured patients.

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Bone mineral and geometric changes through the femur with immobilization due to spinal cord injury.

This cross-sectional study describes bone mineral and geometric properties of the midshaft and distal femur in a control population and examines effects of immobilization due to spinal cord injury (SCI) at these skeletal sites. The subject populations were comprised of 118 ambulatory adults (59 men and 59 women) and 246 individuals with SCI (239 men and 7 women); 30 of these were considered to have acute injury (SCI duration <1 year). Bone mineral density (BMD) was assessed at the femoral neck, and midshaft and distal femur by dual energy absorptiometry. Geometric properties, specifically cortical area, polar moment of inertia, and polar section modulus, were estimated at the midshaft from cortical dimensions obtained by concurrent radiography. Reduction in BMD was noted in all femoral regions (27%, 25%, and 43% for femoral neck, midshaft, and distal femur, respectively) compared with controls. In contrast, although endosteal diameter was enlarged, geometric properties were not significantly reduced in the midshaft attributable to the age-related increase in periosteal diameter. These results suggest that simultaneous assessment of bone mineral and geometric properties may improve clinically relevant evaluation of skeletal status.

Absorptiometry, Photon↗