Subacute posttraumatic ascending myelopathy: a literature review

Abstract

Study design:A literature review.Objectives:Our aim was to summarise the history, epidemiology, aetiological mechanism, pathological study, clinical and radiological evaluation, treatment and prognosis of subacute posttraumatic ascending myelopathy (SPAM).Methods:Medical literature on SPAM were searched in the PubMed, Medline, Ovid and Embase databases. The cases of SPAM reported in literature were analysed, and the history, epidemiology, aetiological mechanism, pathological study, clinical and radiological evaluation, treatment and prognosis of SPAM were summarised.Results:SPAM remains a relatively rare disorder occurring within the first few weeks after spinal cord injury (SCI). The incidence rate ranges from 0.42% to 1% among all SCI. SPAM is likely to occur in young and middle-aged male patients. Risk factors of SPAM include complete injury, low blood pressure, early postoperative mobilisation and nonsurgical treatment.Conclusions:SPAM is well recognised according to typical clinical manifestation and magnetic resonance imaging characteristics. There is no effective therapy for this neurological deterioration. The prognosis of SPAM is poor. There is usually a slight improvement of one or more level(s) below the maximal level of deterioration. The mortality rate is approximately 10%.

Posttraumatic ascending myelopathy after spinal cord injury in a young man: A case report

“…The injury level is reported to be at the thoracic level in 33.3% of the SPAM cases. 11 The case of our study was also a young man with thoracic injury level that ascended to the cervical segments.…”

“…Based on the previous reports, the incidence of SPAM varies between 0.42 to about 1% of SCI cases. 10 , 11 Furthermore, men are more prone to this condition than women, with a male to female ratio of 5 to 1. The injury level is reported to be at the thoracic level in 33.3% of the SPAM cases.…”

Subacute Posttraumatic Ascending Myelopathy

“…Usually, there is a slight improvement of 1 or more levels below the maximally affected level in most cases 2,6,[10][11][12][13]15 . However, sometimes SPAM may be fatal if there is involvement of upper cervical cord or brainstem 8,10 with a mortality rate of approximately 10% 10,25 . Moreover, recovery to the neurological level before deterioration is rarely seen 12 .…”

Outcomes of Anterior Decompression and Anterior Instrumentation in Thoracolumbar Burst Fractures—A Prospective Observational Study With Mid-Term Follow-up

“…SPAM remains a relatively rare disorder after spinal cord injury, which is defined as neurological deterioration ascending $4 vertebral levels above the initial injured site and occurring within the first few weeks after spinal cord injury. 35 Various theories such as alteration in CSF flow, great artery of Adamkiewicz thrombosis, venous thrombosis, infection, apoptosis, secondary injury, inflammatory, or myelitis are proposed for its causation. Risk factors of SPAM include complete injury, low blood pressure, early postoperative mobilization, and nonsurgical treatment.…”