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

Abstract

Study design: Retrospective Case Review. Objectives: To describe the clinical presentation and course of patients with magnetic resonance imaging (MRI) features of subacute progressive ascending myelopathy (SPAM). A rare complication of spinal cord injury. Setting: National Spinal Injuries Centre, Stoke Mandeville Hospital, UK. Materials and methods: A retrospective review of the case notes and MRI studies of 11 cases with typical MRI features of ascending myelopathy presenting to a tertiary Spinal Injuries centre over a 15-year period. Results: Eleven patients were identified with MRI features typical of SPAM, a median of 13 days (mean 24, range 4-86 days) following cord injury. The median number of cord segments involved above the initial insult was 6 (mean 6.2, range 4-11). MRI appearances include extension four or more segments cephalad to the initial cord injured segment, cord expansion and increased intramedullary T2 signal with a rim of cord sparing peripherally. Cord changes and neurological deficits improved over time but did not return to the initial injured level on MRI. One patient died (mortality 9%). Conclusion: SPAM is a rare cause of neurological deterioration following spinal cord injury but may remain subclinical. SPAM most commonly presents as neurological deterioration but may present with shoulder pain, respiratory deterioration or remain subclinical. There are characteristic MRI appearances. It can be fatal.

MRI in acute and subacute post-traumatic spinal cord injury: pictorial review

“…Subacute progressive ascending myelopathy has an associated mortality of up to 10%, although the majority of patients spontaneously improve but rarely regain all of the lost function. 28 Lee et al 32 reported good recovery with cord untethering and duroplasty.…”

“…28,29 The clinical picture is typically one of deterioration in the patient's motor score and an ascending sensory level, although the condition can remain subclinical. This is also described as progressive posttraumatic myelomalacic myelopathy.…”

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

“…9,10 Obvious cerebrospinal fluid pressure (CSFP) elevation has been shown after SCI in preclinical and clinical studies, [11][12][13] and CSFP elevation may lead to neurological dysfunction. 14 Meagher et al 15 and Planner et al 2 reported that disruption of CSF dynamics was the major cause of SPAM. In an SCI animal model, Jones et al 16 found that an enlarged cord immediately occluded the subarachnoid space in severe SCI, and CSF pressure was only partially decreased by epidural decompressive surgery.…”

Subacute delayed ascending myelopathy: not just a post-traumatic disorder

“…Radiological confirmation with MRI is an important criterion for the diagnosis of SDAM. 4 The role of other imaging modalities, such as FDG-PET, in the assessment of SDAM remains unclear.…”