CT scanning and MRI are reserved to rule out differential diagnosis. Though biopsy is seldom indicated, pathological specimens typically show grossly distorted vertebral endplates with extensive microfractures and considerable fibrous tissue interposed in the pseudoarthrosis site. Extensive granulation tissue may be found in the intervening space. Differential diagnosis includes infection and in particular tuberculosis. Osteoarthrosis, tumor, and Padget's disease may all masquerade in rare instances as a Charcot joint.
Treatment is immobilization.
In the past this has been manifested as a non-operative treatment. 6,12 Other options include instrumented and uninstrumented operative fusion. 1,3,4,10 Conservative treatment in the past has included bedrest, casting, and orthotics. These methods appear more suited to the tabetic population in which scant reports exist of limited success in its treatment. They appear poorly adapted to spinal cord injured patients, however, and it is in this population which we now more frequently see Charcot joint.