Imaging Findings in Spinal Neuroarthropathy

Abstract

The literature is reviewed and five case reports are presented. The objective was to review and emphasize the characteristic magnetic resonance imaging and radiologic findings. Spinal neuroarthropathy is a destructive process involving the disc space, the adjoining vertebral bodies, and the facet joints that can be induced by traumatic paralysis as well as tabes dorsalis, syringomyelia, and diabetes mellitus. Five cases of neuropathic spine in two patients with quadriplegia and three patients with paraplegia from the authors' spinal cord unit were reviewed. On plain radiographs and computed tomography scans, the findings of neuropathic spine were similar to those of disc space infection, severe degenerative disease, and skeletal metastasis. Magnetic resonance imaging, however, showed characteristic hypointensity of signal on T1- and T2-weighted images, which makes it possible to differentiate neuropathic spine and infection. In neuropathic spine, neuropathic destructive changes in the vertebral bodies lead to fracture, followed by additional changes, including bone sclerosis, large osteophytes, and loss of disc space. A large paraspinal mass develops because of improper fracture healing. At the end stage of this process, a pseudarthrosis may form, as was evident in three of the five patients reviewed.