Pathological features including apoptosis in subacute posttraumatic ascending myelopathy

Abstract

<jats:p content-type="fine-print">✓ Subacute posttraumatic ascending myelopathy (SPAM) is a rare disorder that may gradually emerge in the first 1 to 3 weeks after a spinal cord injury and is unrelated to syrinx formation or mechanical instability. In addition to several theories that have been put forth to explain the origin of this syndrome, the authors propose a possible role for apoptosis in the causation and the progression of SPAM. They discuss the various theories that have been proposed thus far, to place the role of apoptosis in perspective and use their case as an illustration.</jats:p>

Subacute progressive ascending myelopathy following spinal cord injury: MRI appearances and clinical presentation

“…5 A wide range of treatments have been proposed including anticoagulation, decompression, methylprednisolone and mannitol. There is no evidence for the efficacy or superiority of any particular intervention.…”

“…16,17,18 In SPAM patients, apoptotic cells have been demonstrated at sites within the spinal cord remote to the site of the initial cord injury. 5,19,20 Certainly, apoptotic cells and an altered immune environment are present following spinal cord injury, but their role in SPAM remains unclear. Lastly, I think it is important to acknowledge a few limitations of the imaging used in this case review.…”

“…Most patients make a good recovery but there is a reported mortality of up to 10%, particularly, if the cord involved ascends to the level of the brainstem. 5 The cause for this neurological deterioration is not understood. Hypotheses include vascular injury, further mechanical insult, infection and immune-mediated injury, including apoptosis.…”

“…Ascending cord injury involving at least four segments in the early period following spinal cord injury was first described by Frankel in 1968. Subacute progressive ascending myelopathy (SPAM) represents a rare, poorly understood neurological complication of spinal cord injury [3][4][5][6][7][8] and may develop following an insult to any part of the spinal cord. 4 Patients typically present with an ascending neurological deficit within 3 weeks of the initial spinal cord insult.…”

Subacute post-traumatic ascending myelopathy after T12 burst fracture in a 32-year-old male: case report and surgical result of cervical durotomy

“…A number of conservative interventions, including close observation, maintaining normal blood pressure, anticoagulation, antiapoptotic treatment, physical therapy, steroids and osmolar treatments have been carried out. 1,[3][4][5][6][7] Slight neurological improvement can occur over time in the majority of cases; however, none of these patients return to their baseline level of functioning. Unfortunately, in our case, conservative therapy could not improve SPAM, and the patient had a progressive neurological deterioration for which ventilatory support was required.…”