• De IureFedericoFDepartment of Spine Surgery, Ospedale Maggiore, Largo Nigrisoli 2, 40100, Bologna, Italy, federicodeiure@acantho.it., Mohammadreza Chehrassan, Michele Cappuccio, and Luca Amendola.
• Department of Spine Surgery, Ospedale Maggiore, Largo Nigrisoli 2, 40100, Bologna, Italy, federicodeiure@acantho.it.
• Eur Spine J. 2014 Oct 1; 23 Suppl 6: 604-9.

PurposeTo analyze the role of spine alignment in post-traumatic paraplegic patient as a potential cause of late Charcot spine disease (CSD).MethodA retrospective review of three cases in which the disease appeared more than 15 years after a spinal cord injury treated by posterior fusion. A review of the literature concerning spine balance in sitting position, especially referred to paraplegic patients, is done to validate this hypothesis.ResultsLumbar kyphosis in paraplegic patients during the sitting position may increase the mechanical load on disks and ligament below the previously fused area. This phenomenon, in combination with lack of protective mechanism because of poor muscular support and lack of sensitivity can speed up and amplify the normal degenerative changes in the disk and ligaments.ConclusionsMore investigations are required to fully understand all the mechanisms underlying CSD pathogenesis to prevent it. Until then, a systematic long-term clinical and radiological follow-up in all post-trauma paraplegic patients is suggested. Combined anterior and posterior fusion, when feasible, can restore the sagittal balance providing a better quality of life in these patients.

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