Their conclusion was that posterior segmental instrumentation and fusion was indicated for single level involvement. Anterior augmentation was recommended for multi-level or kyphotic involvement. The additional recommendation was made that no intercurrent unfused segments remain. This has changed the etiology of Charcot spinal arthropathy. Prior methods of treatment appear especially unsuccessful in this new population.
Prospective trials are unlikely in the near future.
On the basis of remote and recent retrospective reviews as well as our own limited experience, we recommend anterior and posterior fusion with instrumentation for Charcot spinal arthropathy. Given the unstable nature of this deformity, its high propensity for kyphotic angulation, and frequency of nonunion, we believe even single level involvement should be fused both anteriorly and posteriorly. Fusion of the Charcot spine. Report of 3 cases. Devlin VJ et al.