Study design <p>A retrospective case series analysing six cases of Charcot spinal arthropathy.</p> Objectives <p>To evaluate the etiology, clinical manifestations (e.g., pain, trunk instability, autonomic dysreflexia, spasticity), latency period before symptom onset, affected spinal regions, and treatment strategies for Charcot spinal arthropathy.</p> Setting <p>National Spinal Injury Centre, United Kingdom.</p> Methods <p>Data were collected and analysed from six patients diagnosed with Charcot spinal arthropathy. Variables examined included the etiology, clinical presentations, spinal regions affected, latency period, and outcomes of treatment approaches. Both conservative management and surgical intervention strategies were evaluated.</p> Results <p>Patients exhibited common clinical manifestations such as pain, loss of trunk control, autonomic dysreflexia, and spasticity, with varying latency periods before symptom onset. The thoracic spine was the most frequently affected region. Conservative management successfully stabilized symptoms in most cases, while surgical intervention was necessary in instances of severe trunk instability, refractory pain, or deformity impacting mobility.</p> Conclusion <p>Conservative management should be the initial treatment approach for Charcot spinal arthropathy. Surgical intervention is reserved for cases with significant clinical progression, such as unresolved pain, mobility restrictions due to trunk deformity, or urgent complications arising from spinal pathology.</p>