Subacute Posttraumatic Ascending Myelopathy

Abstract

Case: A 45-year-old man presented with posttraumatic fracture-dislocation of T11/12 with neurological level T8 AIS A.Sensory level progressed to T4 in the next day morning. He underwent T10, T11, T12, and L1 percutaneous pedicle screwrod fixation. Postoperatively, there was rapid worsening of his neurology and within 48 hours, he became tetraplegic with neurological level C2 with respiratory paralysis requiring mechanical ventilation. He died on the 14th postoperative day. Clinicoradiological findings were consistent with subacute posttraumatic ascending myelopathy (SPAM).Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B809).

Subacute Posttraumatic Ascending Myelopathy After Thoracolumbar Spinal Cord Injury

“…The more distal level of injury in the TL spine was associated with the steeper SPAM ascent, and TL junction injuries had the highest level of SPAM ascent. The highest number of levels ascended at 19 levels was reported in 2 different cases 11,16 , and the second highest was 18 reported in 3 different cases 5,18,24 ; all these 5 cases had an initial injury at the T12/L1 region (Table IV).…”

“…The changes observed on MRI may not correlate with clinical findings at follow-up 9 . MRI to date remains the gold standard for the diagnosis of SPAM; however, the use of computed tomography scan 8 , Cerebrospinal fluid (CSF) examination 2,6,8,24 , lumbar puncture 2,6,8,24 , myelography 2,28 , and selective spinal angiography 6,9 have been reported.…”

“…Hence, we performed an extensive literature review for this entity and analyzed 23 published articles reporting SPAM to date 2,5-25 . Only 29 cases of SPAM in patients with thoracolumbar (TL) trauma were found.…”

“…Only 29 cases of SPAM in patients with thoracolumbar (TL) trauma were found. This review included 19 studies that reported on patients with SPAM after posttraumatic TL injury 2,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][22][23][24] . Cases of SPAM that developed postoperatively for thoracic myelopathy 21 and after an initial injury to the cervical and cervicothoracic spine (C1-C7 and C7-T1 levels) 6,10,17,25 were excluded.…”