Ascending Myelitis in Operated Burst Fracture L1 with Paraplegia Asia

Abstract

Abstract:A 46 years female sustained post-traumatic paraplegia with burst-fracture L1, with ASIA-A neurology, and underwent surgical decompression and stabilization. On 4 th post-operative day, patient developed ascending myelopathy with neurological deterioration upto C5, along with fever, neck rigidity, high counts, with MRI showing myelitis. An aggressive antibiotic therapy was started. Blood counts, fever and neck rigidity settled with a delayed partial neurological recovery at 17 weeks. Infection could not be confirmed as the cause of the ascending myelitis even though the patient responded to antibiotics. Ascending sympathetic myelitis was a differential, which though rare, is reported.

Subacute Posttraumatic Ascending Myelopathy

“…Hence, we reviewed the existing literature on this rare entity to elucidate and analyze SPAM. We found only 28 cases of SPAM after thoracolumbar injury that were reported in the literature 2,[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] . We report a case of SPAM occurring after T11/12 fracture-dislocation with rapid ascent of neurological level with sudden worsening after surgery.…”

Subacute Posttraumatic Ascending Myelopathy After Thoracolumbar Spinal Cord Injury

“…Subacute posttraumatic ascending myelopathy (SPAM) is a rare condition that can occur after SCI and is defined as neurological worsening that ascends 4 or more levels above the initial SCI level, which occurs within the initial days to weeks after SCI, and is unrelated to syrinx formation or mechanical instability 5-12 . Neurological deterioration occurs after a latency period (days to weeks) of stable neurology and is followed by sudden rapid progressive neurological deterioration, and this has been referred to as “subacute.” SPAM occurs as a neurological deterioration between day 1 and 4 weeks of initial SCI 16,19,27 . Most authors defined the upper limit for onset of SPAM as 3 to 4 weeks.…”

“…Neurological deterioration occurs after a latency period (days to weeks) of stable neurology and is followed by sudden rapid progressive neurological deterioration, and this has been referred to as "subacute." SPAM occurs as a neurological deterioration between day 1 and 4 weeks of initial SCI 16,19,27 . Most authors defined the upper limit for onset of SPAM as 3 to 4 weeks.…”

“…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.…”

“…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.…”