Identification of a destructive spinal process in the acute setting most commonly is related to infection or neoplasm. In the appropriate clinical setting, Charcot spine, also known as neuropathic spinal arthropathy or spinal neuroarthropathy, should be considered. We present a case of spinal destruction due to spinal neuroarthropathy in a 51-year-old man who had been paraplegic for 13 years, and review the characteristic and potentially differentiating imaging findings of this uncommon process.