Sub-acute post traumatic ascending myelopathy with superimposed infection in a diabetic: a case report

Shreya Shenoy; C. S. Vishnu Prasath; Manish R.; Sargunan Bala

doi:10.18203/issn.2455-4510.IntJResOrthop20243916

Authors

Shreya Shenoy Department of Orthopaedics, SKS Hospital and Postgraduate Medical Institute, Salem, Tamil Nadu, India
C. S. Vishnu Prasath Department of Spine Surgery, SKS Hospital and Postgraduate Medical Institute, Salem, Tamil Nadu, India https://orcid.org/0000-0002-3207-1255
Manish R. Department of Spine Surgery, SKS Hospital and Postgraduate Medical Institute, Salem, Tamil Nadu, India https://orcid.org/0000-0002-8615-3512
Sargunan Bala Department of Spine Surgery, SKS Hospital and Postgraduate Medical Institute, Salem, Tamil Nadu, India https://orcid.org/0009-0004-8430-8340

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20243916

Keywords:

SPAM, Thoracic spine trauma, Neurological deficit, Post operative complications

Abstract

Subacute posttraumatic ascending myelopathy (SPAM) is a rare entity associated with trauma to the spinal cord, usually at the level of the thoracic spine. Patient presents with neurological deterioration 4 or more levels above the site of primary injury. It usually follows an episode of fever unrelated to infection. A 43-year-old diabetic male patient with history of blunt trauma to thoracic spine with T5 flexion distraction injury with ASIA A neurology, underwent T3-T6 posterior instrumented stabilisation. Four weeks following this, he presented with signs of encephalopathy with CSF culture showing Acinetobacter baumanii. Though the patient had improvement with culture- sensitivity appropriate antibiotics, he developed ascending neurological deficits on day 3 of admission. On repeat MRI, he showed cord oedema up to C3. He was started on steroids and showed remarkable clinical improvement. SPAM must be kept as a differential in the diagnosis of a postoperative event with similar clinical picture.

Metrics

Metrics Loading ...

References

Harrop JS, Sharan AD, Vaccaro AR, Przybylski GJ. The Cause of Neurologic Deterioration After Acute Cervical Spinal Cord Injury. Spine. 2001;26(4):340.

Zhang J, Wang G. Subacute posttraumatic ascending myelopathy: a literature review. Spinal Cord. 2017;55(7):644-50.

Frankel HL. Ascending cord lesion in the early stages following spinal injury. Paraplegia. 1969;7(2):111-8.

Coleman-Bock J, Bäcker HC, Johnson MA, Turner P, Cunningham J. Subacute Posttraumatic Ascending Myelopathy: Case Report and Systematic Review of the Literature. Clin Spine Surg. 2023;36(4):157.

Eric C. Bélanger, Belanger E, Claude Picard, Picard C, Picard C, Daniel Lacerte, et al. Subacute posttraumatic ascending myelopathy after spinal cord injury. Report of three cases. J Neurosurg. 2000;93(2):294-9.

Basu S, Gohil K, Sarangi T. Subacute Posttraumatic Ascending Myelopathy: A Rare Complication After Thoracolumbar Spinal Cord Injury: A Case Report. JBJS Case Connect. 2022;12(1):10.

Bock J, Baecker H, Johnson M, Turner P, Cunningham JE. P158. SPAM: subacute posttraumatic ascending myelopathy is a rare but devastating disorder: what do we know? Spine J. 2022;22(9):S203.

Govekar S, Anand S, Lakshman LP, Vasanthapuram R, Banda RV. Syndrome Evaluation System for Simultaneous Detection Pathogens Causing Acute Encephalitic Syndrome in India, Part-1: Development and Standardization of the Assay. Front Med. 2018;5:208.

Planner AC, Pretorius PM, Graham A, Meagher TM. Subacute progressive ascending myelopathy following spinal cord injury: MRI appearances and clinical presentation. Spinal Cord. 2008;46(2):140-4.

Schmidt BJ. Subacute delayed ascending myelopathy after low spine injury: case report and evidence of a vascular mechanism. Spinal Cord. 2006;44(5):322-5.

Aito S, El Masry WS, Gerner HJ, Lorenzo ND, Pellicanò G, D’Andrea M, et al. Ascending myelopathy in the early stage of spinal cord injury. Spinal Cord. 1999;37(9):617-23.

Jian Z, Zhang J, Huili W, Wang H, Haiying L, Liu H, et al. Subacute post-traumatic ascending myelopathy after T12 burst fracture in a 32-year-old male: case report and surgical result of cervical durotomy. Spinal Cord Ser Cases. 2016;2(1):16004.

Meagher T, Belci M, López de Heredia L. Resolution of SPAM following cordectomy: implications for understanding pathophysiology. Spinal Cord. 2012;50:638-40.

Kumar A, Kumar J, Garg M, Farooque K, Gamanagatti S, Sharma V. Posttraumatic subacute ascending myelopathy in a 24-year-old male patient. Emerg Radiol. 2010;17(3):249-52.

Katoh S, Ikata T, Tsubo M, Hamada Y, El Masry WS. Possible implication of leukocytes in secondary pathological changes after spinal cord injury. Injury. 1997;28(3):215-7.

Fischbein NJ, Dillon WP, Cobbs C, Weinstein PR. The “presyrinx” state: a reversible myelopathic condition that may precede syringomyelia. AJNR Am J Neuroradiol. 1999;20(1):7-20.

Aaron C. Tan, Tan AC, Karl Ng, Ng K, Allison Newey, Newey A, et al. Subacute delayed ascending myelopathy: not just a post-traumatic disorder. Spinal Cord. 2014;52(2):1.

Zhang J, Wang H, Liu H, Wang G. Subacute post-traumatic ascending myelopathy after T12 burst fracture in a 32-year-old male: case report and surgical result of cervical durotomy. Spinal Cord Ser Cases. 2016;2(1):1-4.

Yablon IG, Ordia J, Mortara R, Reed J, Spatz E. Acute Ascending Myelopathy of the Spine. Spine. 1989;14(10):1084.

Belanger E, Picard C, Lacerte D, Lavallee P, Levi AD. Subacute posttraumatic ascending myelopathy after spinal cord injury. Report of three cases. J Neurosurg. 2000;93(2):294-9.

Al-Ghatany M, Al-Shraim M, Levi ADO, Midha R. Pathological features including apoptosis in subacute posttraumatic ascending myelopathy. Case report and review of the literature. J Neurosurg Spine. 2005;2(5):619-23.

Okada S, Saito T, Kawano O, Hayashida M, Matsumoto Y, Harimaya K, et al. Sequential changes of ascending myelopathy after spinal cord injury on magnetic resonance imaging: a case report of neurologic deterioration from paraplegia to tetraplegia. Spine J. 2014;14(12):e9-14.

Esmaeilnia M, Asadi M, Sharara H. Posttraumatic ascending myelopathy after spinal cord injury in a young man: A case report. Clin Case Rep. 2022;10(8):e5997.

Bracken MB, Shepard MJ, Holford TR, Leo-Summers L, Aldrich EF, Fazl M, et al. Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA. 1997;277(20):1597-604.

Lee TT, Arias JM, Andrus HL, Quencer RM, Falcone SF, Green BA. Progressive posttraumatic myelomalacic myelopathy: treatment with untethering and expansive duraplasty. J Neurosurg. 1997;86(4):624-8.

Kovanda TJ, Horn EM. Subacute posttraumatic ascending myelopathy in a 15-year-old boy. J Neurosurg Spine. 2014;21(3):454-7.