Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 21, 2022; 10(3): 1077-1085
Published online Jan 21, 2022. doi: 10.12998/wjcc.v10.i3.1077
Cervical spondylotic myelopathy with syringomyelia presenting as hip Charcot neuroarthropathy: A case report and review of literature
Yu Lu, Jun-Yi Xiang, Cheng-Yu Shi, Ju-Bao Li, Hai-Chao Gu, Chang Liu, Guo-Yu Ye
Yu Lu, Jun-Yi Xiang, Ju-Bao Li, Hai-Chao Gu, Guo-Yu Ye, Department of Orthopedics, Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming 650000, Yunnan Province, China
Cheng-Yu Shi, Department of Management and Economics, Kunming University of Science and Technology, Kunming 650000, Yunnan Province, China
Chang Liu, Department of Sleep Center, The First People's Hospital of Yunnan Province, Kunming 650000, Yunnan Province, China
Author contributions: Lu Y and Ye GY were the patient’s orthopedist, reviewed the literature and contributed to manuscript drafting; Shi CY reviewed the literature and contributed to manuscript drafting; Xiang JY, Li JB, and Gu HC analyzed and interpreted the imaging findings; Liu C performed the psychiatric analyses and interpretation and contributed to manuscript drafting; Lu Y and Ye GY were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Guo-Yu Ye, MM, Attending Doctor, Department of Orthopedics, Yunnan Provincial Hospital of Traditional Chinese Medicine, No. 120 Guanghua Street, Kunming 650000, Yunnan Province, China. yeguoyumed@163.com
Received: June 29, 2021
Peer-review started: June 29, 2021
First decision: September 1, 2021
Revised: September 8, 2021
Accepted: December 22, 2021
Article in press: December 22, 2021
Published online: January 21, 2022
Processing time: 199 Days and 17.2 Hours
Abstract
BACKGROUND

Charcot neuroarthropathy (CN) is a systemic disease characterized by progressive bone loss and destruction, which is usually closely related to diabetes, HIV, etc. However, CN caused by syringomyelia accounts for only 5% of CN cases; the shoulder and elbow are most often involved, and the hip joint is rarely affected. As a rare factor, cervical spondylotic myelopathy (CSM) can be associated with syringomyelia, which is scarcely reported in the literature. Here, we present the first case report to date of CN of the hip caused by syringomyelia secondary to CSM.

CASE SUMMARY

We describe a 76-year-old male patient who was diagnosed with CSM due to neck pain and weakness of limbs 16 years ago. Four years ago, he noticed recurrent swelling of the right hip with pain and was diagnosed with degenerative arthritis. Recently, however, his symptoms gradually worsened, and because of progressive pain, destabilization and weakness of the right hip, he was admitted to our hospital. Through systematic physical, radiographic and laboratory examinations, we finally reached a diagnosis: CN of the right hip associated with syringomyelia secondary to CSM. After comprehensive evaluation of the patient's condition, we performed right total hip arthroplasty. During the follow-up, the patient felt well clinically and could walk independently with a knee brace.

CONCLUSION

We suggest a possible etiological association between CSM and syringomyelia, which may reflect a potential pathogenesis of CN. We encourage clinicians to actively carry out a detailed medical history and comprehensive physical and imaging examinations in patients with joint lesions, especially chronic shoulder neck pain, to rule out the possibility of this association, which plays a crucial role in the early diagnosis of CN. Arthroplasty may no longer be an absolute contraindication to surgical treatment of CN. Reasonable selection of the surgical strategy can markedly improve the clinical symptoms and quality of life of patients.

Keywords: Cervical spondylotic myelopathy; Syringomyelia; Hip; Charcot neuroarthropathy; Case report

Core Tip: We report an unprecedented case of Charcot neuroarthropathy (CN) of the right hip associated with syringomyelia secondary to cervical spondylotic myelopathy (CSM). After comprehensive evaluation of the patient's condition, we performed right total hip arthroplasty. During the follow-up, the patient felt well clinically and could walk independently with a knee brace. We suggest a potential etiological association between CN and CSM complicated by syringomyelia, which reminds clinicians to actively carry out comprehensive physical and imaging examinations in patients with joint lesions, especially chronic shoulder neck pain, to rule out the possibility of this association. Detailed medical history acquisition and comprehensive examination play a crucial role in the early diagnosis of CN. Arthroplasty may no longer be an absolute contraindication to surgical treatment of CN. Reasonable selection of the surgical strategy can markedly improve the clinical symptoms and quality of life of patients.