Resolution of SPAM following cordectomy: implications for understanding pathophysiology

Abstract

Study design: Case report. Objective: 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. Setting: National Spinal Injuries Centre, Stoke Mandeville Hospital, UK. Method and results: 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. Conclusion: Cordectomy can be an effective intervention in case of rapid progressive neurological deterioration.

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

“…This complication, known as subacute posttraumatic ascending myelopathy (SPAM), is defined as neurological deterioration ascending 4 or more vertebral levels above the injury site and occurring within the first few weeks of initial injury that is unrelated to manipulation of an unprotected spinal cord or syrinx formation. [1][2][3]7,10,[14][15][16] Most patients with SPAM present within 3 weeks of injury, unlike our patient who presented 5 weeks postinjury. In cases of SPAM, T2-weighted MRI reveals intramedullary hyperintensity above the original level of injury with cord expansion, similar to what was seen in our patient.…”

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

“…[9][10][11] Suppositions include second injury, arterial or venous infarction, fibrocartilage embolization, infection, apoptosis, autoimmune injury, and cord edema secondary to altered cerebrospinal fluid drainage. 12 Although its precise causation remains unknown, apoptosis may play a significant role in its pathologic mechanism. 11 Patients who undergo early surgical decompression and stabilization have significantly reduced chances of incurring this complication.…”

Ascending Myelitis in Operated Burst Fracture L1 with Paraplegia Asia

“…A wide range of conservative treatments have been suggested in the literature including anticoagulation, decompression, steroids [3] and mannitol. Surgical measures like dural untethering and cordectomy have also been described [8,9]. Our patient was not administered any steroids, and gradually recovered on a three week broad spectrum antibiotic therapy, which we do not know whether was warranted or not.…”