Objective:

Present a rare case of subacute cervical posttraumatic ascending myelopathy (SPAM). 

Background:

SPAM is a rare, delayed complication of spinal cord injury (SCI), which manifests as a neurological deterioration involving at least 4 segments above the initial injured level occurring within the first few weeks following SCI. Given its rarity, there is no consensus on how to manage this condition. We present a case of SPAM with initial injury level at C6 who progressed to involve myelopathic changes up to the C2 level. 

Design/Methods:

NA

Results:

A 62-year-old female presents for acute onset weakness in the bilateral hands after lifting heavy objects. Within hours, the weakness extended caudally producing paraplegia and sensory loss to T4 level. MRI C-spine showed severe canal stenosis with cord compression by a disc osteophyte complex at C6-C7. The patient underwent a posterior decompression and fusion at C5-C7. Over the next two weeks, weakness ascended to upper extremities, graded between 4 and 4+/5. Sensory loss ascended to C8 level. Lumbar puncture only showed mild elevation of protein. Autoimmune, metabolic and toxic workup was negative. EMG showed no evidence of primarily demyelinating polyneuropathy. Given persistence of symptoms, MRI C-spine was repeated three weeks following injury which showed extensive high signal intensity extending from C2 to T3, with cord enhancement at C6-7. A few days later, the patient started improving, and repeat MRI C-spine showed significant decrease in T2 signal abnormality involving the cervical cord, only focally involving C6-7 and C4-5 level corresponding to residual spinal stenosis. Repeat CSF studies were normal. The clinical and radiographic improvement was attributed to resolving SPAM. The patient received no corticosteroids/immunotherapy.  

Conclusions:

Following SCI, SPAM is an important clinical and radiological pattern of neurological deterioration that is frequently underrecognized. This case study provides insight into this disease's natural clinical and radiological progress with no modifying therapy.