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

Abstract

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 thoracoscopicassisted 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.

Medical Communication Services after Traumatic Spinal Cord Injury

“…A lateral position is better for patients who are being monitored by Codman probe, but a ring-shaped pillow can also be used to support patients in a supine position to avoid increasing ISP. Increases in pressure can cause subacute posttraumatic ascending myelopathy [ 55 ]. In some instances, aggravated venous hypertension and/or arterial hypotension at the injury site and equivalent degrees of dural occlusion can cause loss of branch blood flow, which may lead to impaired spinal cord perfusion and can produce additional secondary injury [ 56 ].…”

Subacute Posttraumatic Ascending Myelopathy After Thoracolumbar Spinal Cord Injury

“…Surgical decompression was performed to reduce the increased CSF pressure with an attempt at SPAM resolution in 2 cases in accordance with the CSF flow alteration hypothesis in SPAM 12,18 . Yablon et al 28 suggested early surgical decompression after the initial SCI could prevent SPAM.…”

“…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.…”

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.…”