Subacute Posttraumatic Ascending Myelopathy Research Articles

Subacute Posttraumatic Ascending Myelopathy After Thoracolumbar Spinal Cord Injury.

Subacute posttraumatic ascending myelopathy (SPAM) is defined as neurological deterioration ascending four or more levels above the initial injury level and occurring within the initial days to weeks after spinal cord injury (SCI). SPAM is a rare complication of spinal cord injury with an incidence of 0.42% to 1% affecting young to middle-aged male patients. Several hypotheses have been put forth to explain SPAM, but the exact pathomechanism remains elusive. Treatment guidelines for this rare entity are uncertain and still to be developed. The current prognosis of SPAM is poor, with a mortality rate of 10.34%.

P158. SPAM: subacute posttraumatic ascending myelopathy is a rare but devastating disorder: what do we know?

<h3>BACKGROUND CONTEXT</h3> Subacute posttraumatic ascending myelopathy (SPAM) is a rare, potentially fatal disorder characterized by progressive neurological deterioration in a surgically stabilized, posttraumatic spine. The deficit cannot be attributable to ongoing mechanical instability, syrinx formation or iatrogenic causes. <h3>PURPOSE</h3> To report the incidence and potential treatments of SPAM we performed a systematic review. <h3>STUDY DESIGN/SETTING</h3> The systematic search for medical literature on SPAM following the PRISMA guidelines was performed on Medline, Ovid, Cochrane, Embase and PubMed databases between 1969 and August 2021. <h3>PATIENT SAMPLE</h3> Of the 904 abstracts identified for this search term, 18 articles were included for final analysis. Cases were reviewed and the findings summarized. <h3>OUTCOME MEASURES</h3> The search term was (ascending myelopathy) and all articles reporting SPAM in English were included. <h3>METHODS</h3> Within the 18 articles, a total of 39 cases were reported. It is estimated to occur in 0.4-0.7% of spinal cord injuries. The mortality rate is up to 10% primarily due to respiratory compromise. <h3>RESULTS</h3> It effects predominately male patients (71.9%) in the age group between 21 and 30 years (n=15/39; 38.9%). The latent period prior to onset ranges from 1 day to almost 3 months with the mean between 1 and 2 weeks. It can cause either partial or complete motor and/or sensory deficits. Patients typically describe pain or sensory changes above the level of the traumatic spinal cord injury. Pyrexia was described by five authors with no underlying cause found. The typical MRI changes seen in SPAM is a central region of T2 weighted hyper intensity, with generalized cord expansion and occasionally cord surrounding lesions, most commonly proximal to the original injury. Fortunately, there is long term potential for improvement in neurological impairment. <h3>CONCLUSIONS</h3> This systematic review shows that the incidence rate of SPAM is low but the mortality rate is high; up to 10%. There is no efficient way to predict the onset and there is no effective treatment of this condition. However, there is some evidence that monitoring CSF pressures following spinal cord injury this may help confirm the aetiology and suggest therapies such as drains or expansion duraplasty to reduce spinal cord pressures. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

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

To draw attention to a rare neurological deterioration after spinal cord injury (SCI) and to discuss evidence supporting an increase in cerebrospinal fluid pressure (CSFP), we present an extremely rare case of subacute post-traumatic ascending myelopathy (SPAM) in which the patient sustained a T12 fracture initially resulting in paraplegia and after undergoing posterior fixation and anterior decompression. The patient was a 32-year-old healthy man who sustained a T12 burst fracture with complete paraplegia after a fall injury. The patient underwent a posterior reduction and short-segment fixation 8 h after the injury and an anterior thoracoscopic-assisted decompression on post-traumatic day 8. On post-traumatic day 21, he had a progressive neurological deterioration with dyspnoea and decreased muscle strength of both upper extremities that could not be relieved by conservative intervention. After undergoing a cervical posterior laminectomy and durotomy, the patient exhibited the clinical manifestation of brain herniation. There was no recovery of autonomous respiration, and the patient entered a coma. The patient died on post-traumatic day 25 because of cardiac and respiratory arrest. SPAM is a rare, potentially fatal neurological deterioration after SCI; however, a prompt diagnosis can be made by magnetic resonance imaging. Our observations suggest that an increase in CSFP may be the main cause of SPAM. The paraplegic level should be recorded daily so that neurological deterioration can be recognised as soon as possible.

Subacute Posttraumatic Ascending Myelopathy After Excessive Closed Reduction of Bilateral Cervical Facet Dislocation

Subacute Posttraumatic Ascending Myelopathy After Excessive Closed Reduction of Bilateral Cervical Facet Dislocation

Subacute posttraumatic ascending myelopathy in a 15-year-old boy

Secondary injury following initial spinal cord trauma is uncommon and frequently attributed to mismanagement of an unprotected cord in the acute time period after injury. Subacute posttraumatic ascending myelopathy (SPAM) is a rare occurrence in the days to weeks following an initial spinal cord injury that is unrelated to manipulation of an unprotected cord and involves 4 or more vertebral levels above the original injury. The authors present a case of SPAM occurring in a 15-year-old boy who sustained a T3-4 fracture-dislocation resulting in a complete spinal cord injury, and they highlight the imaging findings and optimum treatment for this rare event.

Resolution of SPAM following cordectomy: implications for understanding pathophysiology

Case report. To describe the clinical benefit of a spinal cordectomy with the aim of limiting neurological deterioration related to the development of a subacute posttraumatic ascending myelopathy (SPAM) supporting previously described mechanism for SPAM formation. National Spinal Injuries Centre, Stoke Mandeville Hospital, UK. A 38-year old patient presented 6 months after spinal cord injury substantial neurological deterioration expanding from the initial T4-injury level through C4. Magnetic resonance imaging revealed intra-medullary haemorrhage at the site of injury and subsequent-ascending cord oedema. A cordectomy was performed leading to neurological stabilisation and complete resolution of SPAM. Cordectomy can be an effective intervention in case of rapid progressive neurological deterioration.

Pathological features including apoptosis in subacute posttraumatic ascending myelopathy

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.