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Bansal K, Guha M, Gupta A. Spontaneous-Onset Delayed Spinal Arachnoiditis With Dorsal Cord Herniation in a 29-Year-Old Paraplegic Patient: A Case Report. Cureus 2023; 15:e51374. [PMID: 38292951 PMCID: PMC10825720 DOI: 10.7759/cureus.51374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/01/2024] Open
Abstract
Spinal adhesive arachnoiditis is a rare occurrence with a diverse etiology. The clinical picture is not universal, and varying degrees of neurodeficit have been mentioned. Spontaneous spinal cord herniation or idiopathic spinal cord herniation occurs due to displacement of the cord through a dural or arachnoid defect. We report a case of a 29-year-old male paraplegic patient with a nontraumatic spinal cord injury (SCI) following surgery for an intradural extramedullary lesion at T10-T11 level who developed loss of truncal balance after two years of the index surgery. After a thorough clinical examination and MRI as well as other investigations, the patient was diagnosed as having spontaneous-onset delayed spinal arachnoiditis with dorsal cord herniation through the laminectomy window with effacement of neural tissue and ascending edema up to T6 level. A new-onset weakness or the development of an ascending loss of sensory level with a loss of truncal balance should alarm the therapist about some new pathology happening at the cord level in patients with SCI. In this regard, spinal adhesive arachnoiditis with or without cord herniation should always be suspected in a paraplegic patient with delayed-onset deterioration of neurology. Differential diagnoses like arachnoid web and arachnoid cysts should also be kept in mind.
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Affiliation(s)
- Kuldeep Bansal
- Spine Services, Indian Spinal Injuries Center, New Delhi, IND
| | - Mayukh Guha
- Spine Services, Indian Spinal Injuries Center, New Delhi, IND
| | - Anuj Gupta
- Spine Surgery, Max Superspeciality Hospital, New Delhi, IND
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Kaya O, Erdogan S, Ozkunt O, Kaya E, Ozturk C. Subacute ascending myelopathy in adolescent athlete after spinal cord injury: a case report on dynamic complication of spine trauma. Br J Neurosurg 2023; 37:1211-1214. [PMID: 33074727 DOI: 10.1080/02688697.2020.1834512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Subacute post-traumatic ascending myelopathy (SPAM) is a rare complication after spinal cord injury (SCI). SPAM onsets within few days or weeks after initial SCI. Here, we present an adolescent male athlete who developed SPAM after SCI and brief review of literature. Previous reports almost all were about adult patients. Here, we present second adolescent case in the literature. CASE DESCRIPTION A 15 years old adolescent athlete presented to A&E with a T10-T11 fracture dislocation of the spine and a SCI. He underwent T9-L1 posterior instrumentation and decompression. On the 11th post injury, he complained numbness of the T4 dermatome and by the 14th day, he had become tetraplegia with paralysis of the arms and required ventilation. MRI revealed C3-T10 cord changes on T2 weighed images. He received high dose methylprednisolone for 3 weeks. At one-year follow up he had fully recovered arm motor power and improved light touch and pin prick sensation. CONCLUSIONS SPAM may occur in adolescents with a good prognosis. Our case is well example against for proposal of arterial hypothesis.
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Affiliation(s)
- Ozcan Kaya
- Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Sinan Erdogan
- Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
| | - Okan Ozkunt
- Istanbul Memorial Hizmet Hospital, Istanbul, Turkey
| | - Ebru Kaya
- Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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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; 36:157-162. [PMID: 36253913 DOI: 10.1097/bsd.0000000000001394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/17/2022] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Case report and literature review. OBJECTION Aim of this study was to summarize the current evidence base behind subacute posttraumatic ascending myelopathy (SPAM) including the epidemiology, presentation, diagnosis, prognosis, and etiology. SUMMARY OF BACKGROUND DATA SPAM is a rare, potentially fatal disorder which is not attributable to ongoing mechanical instability, syrinx formation, or iatrogenic causes. METHODS A systematic literature search on SPAM was performed on Medline, Ovid, Cochrane, Embase, and PubMed databases between 1969 and 2021. Cases were reviewed and the findings summarized. Further evidence was reviewed to support the hypothesis that disruption of cerebrospinal fluid (CSF) circulation is the underlying etiology of the condition. RESULTS It is estimated to occur in 0.4%-0.7% of spinal cord injuries and may have a mortality of up to 10%. The most likely etiology disruption of CSF circulation leading to further damage to the spinal cord presumably through pressure mediated effects such as a reduction in cellular perfusion. CONCLUSION There is effectively no treatment of this condition, however, with interest developing in monitoring of CSF pressures during spinal cord injury this may help confirm the etiology, and allow the suggestion of therapies such as drains or expansion duraplasty to reduce spinal cord pressures. LEVEL OF EVIDENCE Level II-case report and systematic review.
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Visagan R, Bandi S, Robinson L, Gadhok A, Saadoun S, Papadopoulos MC. Chronic relapsing ascending myelopathy: a treatable progressive neurological syndrome following traumatic spinal cord injury. Br J Neurosurg 2022; 36:792-795. [PMID: 35867035 DOI: 10.1080/02688697.2022.2102146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND We describe a novel progressive neurological syndrome complicating traumatic spinal cord injury (TSCI). Based on clinical and radiological features, we propose the term 'Chronic Relapsing Ascending Myelopathy' (CRAM). We distinguish between the previously described sub-acute progressive ascending myelopathy (SPAM) and post-traumatic syringomyelia (PTS), which may lie on a spectrum with CRAM. CASE REPORT A 60-year-old man sustained a T4 ASIA-A complete TSCI. Four months post-injury, he developed a rapidly progressive ascending sensory level to C4. Clinical and radiological evaluation revealed ascending myelopathy with progressive T2 hyper-intense cord signal change. He underwent cord detethering and expansion duroplasty. Following an initial dramatic resolution of symptoms, the patient sustained two relapses, each 1-month post-discharge characterised by recurrence of disabling ascending sensory changes, each correlating with the radiological recurrence of cord signal change. Symptoms and radiological signal change permanently resolved with more extensive detethering and expansion duroplasty. There is radiological and clinical resolution at 1-year follow-up. CONCLUSION Acute neurological deterioration post-TSCI may be due to SPAM or may occur after years due to PTS. We propose CRAM as a previously unrecognised phenomenon. The radiological characteristics overlap with SPAM. However, CRAM presents later and, clinically, behaves like PTS, but without cord cystic change. Cord detethering with expansion duroplasty are an effective treatment.
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Affiliation(s)
- Ravindran Visagan
- Academic Neurosurgery Unit, Molecular & Clinical Science Research Institute, St George's, University of London, London, UK
| | - Surendra Bandi
- Spinal Treatment Centre, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK
| | - Louise Robinson
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | - Samira Saadoun
- Academic Neurosurgery Unit, Molecular & Clinical Science Research Institute, St George's, University of London, London, UK
| | - Marios C Papadopoulos
- Academic Neurosurgery Unit, Molecular & Clinical Science Research Institute, St George's, University of London, London, UK
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Basu S, Gohil K. Subacute Posttraumatic Ascending Myelopathy After Thoracolumbar Spinal Cord Injury. JBJS Rev 2022; 10:01874474-202210000-00004. [PMID: 36206362 DOI: 10.2106/jbjs.rvw.22.00097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
➢ Subacute posttraumatic ascending myelopathy (SPAM) is defined as neurological deterioration ascending four or more levels above the initial injury level and occurring within the initial days to weeks after spinal cord injury (SCI). ➢ SPAM is a rare complication of spinal cord injury with an incidence of 0.42% to 1% affecting young to middle-aged male patients. ➢ Several hypotheses have been put forth to explain SPAM, but the exact pathomechanism remains elusive. ➢ Treatment guidelines for this rare entity are uncertain and still to be developed. ➢ The current prognosis of SPAM is poor, with a mortality rate of 10.34%.
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Affiliation(s)
- Saumyajit Basu
- Department of Spine Surgery, Kothari Medical Centre, Kolkata, India
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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:e5997. [PMID: 35949408 PMCID: PMC9353859 DOI: 10.1002/ccr3.5997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 05/05/2022] [Accepted: 05/21/2022] [Indexed: 11/28/2022] Open
Abstract
A 29‐year‐old man developed subacute posttraumatic ascending myelopathy 5 days after a spinal cord injury. He developed a fever and a blood culture showed an Alkaligenes spp. infection. Despite antibiotic and high‐dose corticosteroid therapy, same neurological deficits persisted, and a follow‐up MRI showed atrophy and swelling in the cervical cord.
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Affiliation(s)
- Mostafa Esmaeilnia
- Department of Neurological Surgery, Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
| | - Mona Asadi
- Neurologist, Department of neurology Sabzevar University of Medical Sciences Sabzevar Iran
| | - Hussein Sharara
- Resident of neurology Mashhad University of Medical Sciences Mashhad Iran
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Very rare incidence of ascending paralysis in a patient of traumatic spinal cord injury: a case report. Spinal Cord Ser Cases 2022; 8:69. [PMID: 35882848 PMCID: PMC9325770 DOI: 10.1038/s41394-022-00536-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 07/08/2022] [Accepted: 07/17/2022] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION After spinal cord injury, further neurological deterioration up to one to two neurological levels is not uncommon. Late neurological deterioration can occur after two months, mainly due to the syrinx formation. In a rare case like in sub-acute post-traumatic ascending myelopathy, the neurological level may ascend more than four levels from the initial level of injury and it usually starts within a few weeks after injury. CASE PRESENTATION Our case was diagnosed as a case of traumatic spinal cord injury having a lower thoracic neurological level of injury initially, which rapidly progressed over a few weeks into a higher thoracic neurological level. He was operated with pedicle screw fixation of the spine before admission to rehabilitation unit. He was having progressive ascending neurological deterioration, starting a few days after surgery, which was evident by the progression of neurological level by more than four segments clinically. Cerebrospinal fluid(CSF) study showed no significant abnormality. Magnetic resonance imaging (MRI) study showed involvement of the spinal cord at the upper thoracic region. Patient was monitored to note any further worsening. Rehabilitation and supportive measures were provided according to standard protocol. DISCUSSION Very few cases of ascending paralysis of more than four levels have been reported globally. It results in increased morbidity and mortality in spinal cord injury patients. In our case few possible reasons are ruled out but the actual underlying reason was not clear. Various hypotheses have been proposed as the cause in previous published literatures. Management is mostly supportive.
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8
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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; 12:01709767-202203000-00052. [PMID: 35171854 DOI: 10.2106/jbjs.cc.21.00822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 45-year-old man presented with posttraumatic fracture-dislocation of T11/12 with neurological level T8 AIS A. Sensory level progressed to T4 in the next day morning. He underwent T10, T11, T12, and L1 percutaneous pedicle screw-rod fixation. Postoperatively, there was rapid worsening of his neurology and within 48 hours, he became tetraplegic with neurological level C2 with respiratory paralysis requiring mechanical ventilation. He died on the 14th postoperative day. Clinicoradiological findings were consistent with subacute posttraumatic ascending myelopathy (SPAM). CONCLUSION Surgeons must be vigilant in days and weeks after spinal cord injury for early recognition and management of SPAM. Treatment guidelines are uncertain and yet to be developed.
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Affiliation(s)
- Saumyajit Basu
- Department of Spine Surgery, Kothari Medical Centre, Kolkata, India
| | - Kushal Gohil
- Department of Spine Surgery, Kothari Medical Centre, Kolkata, India
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Grassner L, Riemenschneider MJ, Altendorfer B, Grillhösl A, Arevalo-Martin A, Garcia-Ovejero D, Mach O, Maier D, Bierschneider M, Strowitzki M, Thomé C, Aigner L. Subarachnoid Fibrosis in Human Post-Traumatic Syringomyelia: A Prospective Observational Clinical Study. J Neuropathol Exp Neurol 2022; 81:149-153. [DOI: 10.1093/jnen/nlab121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lukas Grassner
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
- Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau am Staffelsee, Germany
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
- ParaMove, Paracelsus Medical University Salzburg and Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau am Staffelsee, Germany
| | | | - Barbara Altendorfer
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
| | - Andreas Grillhösl
- Department of Neuroradiology, Trauma Center Murnau, Murnau am Staffelsee, Germany
| | - Angel Arevalo-Martin
- Laboratory of Neuroinflammation, Hospital Nacional de Paraplejicos (SESCAM), Toledo, Spain
| | - Daniel Garcia-Ovejero
- Laboratory of Neuroinflammation, Hospital Nacional de Paraplejicos (SESCAM), Toledo, Spain
| | - Orpheus Mach
- Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau am Staffelsee, Germany
- ParaMove, Paracelsus Medical University Salzburg and Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau am Staffelsee, Germany
| | - Doris Maier
- Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau am Staffelsee, Germany
- ParaMove, Paracelsus Medical University Salzburg and Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau am Staffelsee, Germany
| | | | - Martin Strowitzki
- Department of Neurosurgery, Trauma Center Murnau, Murnau am Staffelsee, Germany
| | - Claudius Thomé
- Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
| | - Ludwig Aigner
- Institute of Molecular Regenerative Medicine, Paracelsus Medical University, Salzburg, Austria
- Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University, Salzburg, Austria
- ParaMove, Paracelsus Medical University Salzburg and Center for Spinal Cord Injuries, Trauma Center Murnau, Murnau am Staffelsee, Germany
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Alshorman J, Wang Y, Zhu F, Zeng L, Chen K, Yao S, Jing X, Qu Y, Sun T, Guo X. Medical Communication Services after Traumatic Spinal Cord Injury. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:4798927. [PMID: 34512936 PMCID: PMC8424255 DOI: 10.1155/2021/4798927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 12/28/2022]
Abstract
It is difficult to assess and monitor the spinal cord injury (SCI) because of its pathophysiology after injury, with different degrees of prognosis and various treatment methods, including laminectomy, durotomy, and myelotomy. Medical communication services with different factors such as time of surgical intervention, procedure choice, spinal cord perfusion pressure (SCPP), and intraspinal pressure (ISP) contribute a significant role in improving neurological outcomes. This review aims to show the benefits of communication services and factors such as ISP, SCPP, and surgical intervention time in order to achieve positive long-term outcomes after an appropriate treatment method in SCI patients. The SCPP was found between 90 and 100 mmHg for the best outcome, MAP was found between 110 and 130 mmHg, and mean ISP is ≤20 mmHg after injury. Laminectomy alone cannot reduce the pressure between the dura and swollen cord. Durotomy and duroplasty considered as treatment choices after severe traumatic spinal cord injury (TSCI).
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Affiliation(s)
- Jamal Alshorman
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yulong Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Fengzhao Zhu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Lian Zeng
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Kaifang Chen
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Sheng Yao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xirui Jing
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yanzhen Qu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Tingfang Sun
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xiaodong Guo
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Miyao Y, Sasaki M, Taketsuna S, Yokota C, Umegaki M. Early Development of Syringomyelia after Spinal Cord Injury: Case Report and Review of the Literature. NMC Case Rep J 2020; 7:217-221. [PMID: 33062572 PMCID: PMC7538465 DOI: 10.2176/nmccrj.cr.2019-0297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/23/2020] [Indexed: 11/30/2022] Open
Abstract
We report a case of post-traumatic syringomyelia (PTS), which developed 2 months after spinal cord injury (SCI). A 20-year-old man who was involved in a motorcycle accident sustained a complete SCI resulting from a burst fracture of the T5 vertebral body. He underwent posterior fixation with decompression at another hospital 2 days after the injury. Postoperative imaging suggested that spinal stenosis endured at the T4 level and swelling of the spinal cord above that level. Two months later, he felt dysesthetic pain in his forearms and hands, but the cause of the pain was not examined in detail. Four months after the injury, he presented with motor weakness in the upper extremities. Magnetic resonance imaging (MRI) showed syringomyelia ascending from the T3 level to the C1 level, and he was referred to our hospital immediately. The imaging studies suggested that PTS was caused by congestion of the cerebrospinal fluid (CSF) at the T3 level. The patient was treated with syringosubarachnoid (SS) shunt at the T1-T2 level, whereby neurological symptoms of the upper extremities were immediately relieved. Postoperative MRI showed shrinkage of the syrinx. At the latest follow-up 2 years postoperatively, there was no sign of recurrence. It is noteworthy that PTS potentially occurs in the early phase after severe SCI. We discuss relevant pathology and surgical treatment through a review of previous literature.
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Affiliation(s)
- Yasuyoshi Miyao
- Department of Neurosurgery, Suita Municipal Hospital, Suita, Osaka, Japan
| | - Manabu Sasaki
- Department of Neurosurgery, Iseikai Hospital, Osaka, Osaka, Japan
| | | | - Chisato Yokota
- Department of Neurosurgery, Suita Municipal Hospital, Suita, Osaka, Japan
| | - Masao Umegaki
- Department of Neurosurgery, Iseikai Hospital, Osaka, Osaka, Japan
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Levi V, Franzini A, Di Cristofori A, Bertani G, Pluderi M. Subacute posttraumatic ascending myelopathy (SPAM): A potential complication of subarachnoid shunt for syringomyelia? J Spinal Cord Med 2020; 43:714-718. [PMID: 30156977 PMCID: PMC7534218 DOI: 10.1080/10790268.2018.1512735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Context: Treatment of primary spinal syringomyelia is still controversial. Among others, shunting syrinx fluid to the subarachnoid, peritoneal or pleural space has been utilized with varying success. Shunt obstruction, migration, and infection represent the most common complications of these procedures. Findings: The authors present the case of an 81-year-old woman who developed an unusual neurological deterioration resembling a subacute posttraumatic ascending myelopathy (SPAM) after the insertion of a syringosubarachnoid shunt for the treatment of slow-growing D10 syringomyelia. Conclusion/Clinical Relevance: To date, no cases of SPAM secondary to the insertion of a syringosubarachnoid shunt for the treatment of syringomyelia have been reported. The potential pathogenesis related to this phenomenon is discussed.
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Affiliation(s)
- Vincenzo Levi
- Department of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Andrea Franzini
- Department of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Andrea Di Cristofori
- Department of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Giulio Bertani
- Department of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Mauro Pluderi
- Department of Neurosurgery, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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Qatomah AY, Alhabter A, Alqahtani A, Albshabshi A, Alnaami I. Subacute progressive ascending myelopathy following motor vehicle accident. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04813-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Aydoseli A, Özgen U, Akgül T, Orhan EK, Adıyaman AE, Can H, Karadağ C. Subacute Traumatic Ascending Myelopathy in a 28-Year-Old Man: A Rare Case. World Neurosurg 2019; 128:143-148. [PMID: 31042601 DOI: 10.1016/j.wneu.2019.04.168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Subacute posttraumatic ascending myelopathy (SPAM) involves the rise in high signal intensity on T2-weighted images ≥4 vertebral segments above the initial injured site, and it usually occurs within the first few weeks after the injury. The pathophysiologic mechanisms of traumatic spinal cord damage are not clearly understood; however, there are some pathophysiologic processes such as arterial thrombosis, venous thrombosis, congestive ischemia, inflammatory or autoimmune reaction, and infection in the form of meningitis or myelitis that could lead to SPAM. CASE DESCRIPTION We present a case of T7 fracture because of left shoulder gunshot injury and ascending myelopathy up to the C2 vertebra level, which occurred 1 week after the gunshot injury, without pretraumatic cervical injury or syringomyelia. Although control magnetic resonance imaging findings showed the second rise in the high signal intensity level of the spinal cord, T2-weighted signal intensity and cord edema decreased and the patient showed neurologic improvement. CONCLUSIONS This was the first case in the literature that showed rise 2 times in high signal intensity level in the spinal cord because of gunshot injury. Inflammatory reactions and secondary injury processes might have led to neurologic deterioration and ascending myelopathy in our case; therefore, the patient may have shown neurologic improvement after methylprednisolone therapy because of its anti-inflammatory and antiedema effects. There is no clear evidence whether neurologic improvement is associated with steroid therapy or it is because of the natural course of SPAM.
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Affiliation(s)
- Aydın Aydoseli
- Department of Neurosurgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Utku Özgen
- Department of Neurosurgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey.
| | - Turgut Akgül
- Department of Orthopaedics and Traumatology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Elif Kocasoy Orhan
- Department of Neurology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Ali Ekrem Adıyaman
- Department of Neurosurgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Halil Can
- Department of Neurosurgery, Medicine Hospital, Istanbul, Turkey; Department of Neurosurgery, Biruni University, Istanbul, Turkey
| | - Cihat Karadağ
- Department of Neurosurgery, University Hospital Dusseldorf, Dusseldorf, Germany
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15
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Subacute Progressive Ascending Myelopathy. Neuroradiology 2019. [DOI: 10.1016/b978-0-323-44549-8.00032-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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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 2017; 2:16004. [PMID: 28053748 DOI: 10.1038/scsandc.2016.4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 02/10/2016] [Accepted: 02/13/2016] [Indexed: 11/09/2022] Open
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 thoracoscopic-assisted 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.
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Affiliation(s)
- Jian Zhang
- Number 1 Department of Orthopedic Surgery, Baodi Hospital , Tianjin, China
| | - Huili Wang
- Number 1 Department of Orthopedic Surgery, Baodi Hospital , Tianjin, China
| | - Haiying Liu
- Department of Spinal Surgery, Peking University People's Hospital , Beijing, China
| | - Guangshun Wang
- Department of Thoracic Surgery, Baodi Hospital , Tianjin, China
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Zhang J, Wang G. Subacute posttraumatic ascending myelopathy: a literature review. Spinal Cord 2016; 55:644-650. [PMID: 27995944 PMCID: PMC5504449 DOI: 10.1038/sc.2016.175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 10/19/2016] [Accepted: 10/29/2016] [Indexed: 11/20/2022]
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%.
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Affiliation(s)
- J Zhang
- Department of Orthopedic Surgery, Tianjin Baodi Hospital, Tianjin, China
| | - G Wang
- Department of Thoracic Surgery, Tianjin Baodi Hospital, Tianjin, China
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Miller BA, Roy AK, Boucher AB, Pradilla G, Ahmad FU. Subacute Posttraumatic Ascending Myelopathy After an Incomplete Spinal Cord Injury from a Gunshot Wound to the Spine: Case Report and Review of the Literature. World Neurosurg 2016; 88:687.e13-687.e17. [DOI: 10.1016/j.wneu.2015.11.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 11/11/2015] [Accepted: 11/14/2015] [Indexed: 10/22/2022]
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Abstract
The goal of imaging in spine trauma is to gauge the extent of bony, vascular, and neurologic compromise. Neurologic and mechanical stability are key pieces of information that must be efficiently communicated to the referring clinician. From immobilization and steroid therapy, to vascular repair and emergent surgical intervention, clinical outcomes of spine-injured patients depend on timely and well-chosen imaging studies. Multidetector computed tomography (CT) has essentially replaced radiography in clearance of the spine and is the gold standard in evaluation of the bony spinal column. Magnetic resonance imaging (MRI) is typically reserved for patients with neurologic deficits or for obtunded/impaired patients in whom the neurologic exam is not reliable, even in the absence of osseous injury on CT. MRI is the only available imaging modality that is able to clearly depict the internal architecture of the spinal cord, and, as such, has a central role in depicting parenchymal changes resulting from injury. Intramedullary edema and hemorrhage have been shown to correlate with the degree of neurologic deficit and prognosis. Moreover, advanced MRI techniques, such as diffusion and diffusion tensor imaging, have shifted the focus to determining structural and functional integrity of neural structures. Here, we review the role of imaging in spine trauma, as well as the key radiologic features of injury to the spinal column and spinal cord.
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Affiliation(s)
- Vahe M Zohrabian
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT, USA.
| | - Adam E Flanders
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Okada S, Saito T, Kawano O, Hayashida M, Matsumoto Y, Harimaya K, Iwamoto Y. 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:e9-e14. [PMID: 25200328 DOI: 10.1016/j.spinee.2014.08.449] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 08/01/2014] [Accepted: 08/24/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Marked neurologic deterioration within a few days of traumatic spinal cord injury, known as subacute posttraumatic ascending myelopathy, is rare. Although several hypotheses regarding the pathogenesis of this condition have been proposed, the details remain elusive. PURPOSE To report a case of ascending myelopathy in which a series of magnetic resonance images (MRIs) taken through the course of the illness helped follow the course of the disease and discuss possible pathogenesis. STUDY DESIGN Case report and review of the literature. PATIENT SAMPLE A 75-year-old woman involved in a motor vehicle collision sustained a fracture dislocation of T7-T8 with complete paraplegia below T8. METHODS Neurologic examination and radiologic imaging taken by various means. RESULTS Posterior surgical stabilization was performed 18 hours after the injury. Both the surgical and postsurgical courses were uneventful. Four days after the injury, however, the patient reported feeling a tingling sensation in the right-hand fingers and gradually suffered from motor weakness of the upper extremities, deteriorating within a few hours to complete tetraplegia and ventilator dependence. Subsequent cervicothoracic MRI showed abrupt cord swelling with abnormal areas of signal intensity in the cervical and upper thoracic spinal cord during the interval between the onset of tingling and the development of motor paralysis in the arms. On the 20th postsurgical day, an area of hypointensity within the region of high intensity was observed on T2-weighted MRIs, indicating intramedullary spinal cord hemorrhage. CONCLUSIONS Our MRI findings suggest that systemically increased intraspinal pressure resulting from the impairment of spinal venous drainage is involved in the pathogenesis of ascending myelopathy. Although ascending myelopathy is often thought to be partly reversible, persisting increase of the intraspinal pressure may result in intramedullary hemorrhage and irreversible neurologic deficit.
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Affiliation(s)
- Seiji Okada
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Takeyuki Saito
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Osamu Kawano
- Department of Orthopedic Surgery, Spinal Injuries Center, 550-4 Igisu, Iizuka, Fukuoka, 820-8508, Japan
| | - Mitsumasa Hayashida
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yoshihiro Matsumoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Katsumi Harimaya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yukihide Iwamoto
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Subacute delayed ascending myelopathy: not just a post-traumatic disorder. Spinal Cord 2014; 52 Suppl 2:S11-3. [DOI: 10.1038/sc.2014.82] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 04/10/2014] [Accepted: 04/28/2014] [Indexed: 11/08/2022]
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Abstract
Secondary injury following initial spinal cord trauma is uncommon and frequently attributed to mismanagement of an unprotected cord in the acute time period after injury. Subacute posttraumatic ascending myelopathy (SPAM) is a rare occurrence in the days to weeks following an initial spinal cord injury that is unrelated to manipulation of an unprotected cord and involves 4 or more vertebral levels above the original injury. The authors present a case of SPAM occurring in a 15-year-old boy who sustained a T3-4 fracture-dislocation resulting in a complete spinal cord injury, and they highlight the imaging findings and optimum treatment for this rare event.
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Affiliation(s)
- Timothy J Kovanda
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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A Rare Presentation of Subacute Progressive Ascending Myelopathy Secondary to Cement Leakage in Percutaneous Vertebroplasty. Am J Phys Med Rehabil 2014; 93:431-6. [PMID: 24322431 DOI: 10.1097/phm.0000000000000028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Borgens RB, Liu-Snyder P. Understanding secondary injury. QUARTERLY REVIEW OF BIOLOGY 2012; 87:89-127. [PMID: 22696939 DOI: 10.1086/665457] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Secondary injury is a term applied to the destructive and self-propagating biological changes in cells and tissues that lead to their dysfunction or death over hours to weeks after the initial insult (the "primary injury"). In most contexts, the initial injury is usually mechanical. The more destructive phase of secondary injury is, however, more responsible for cell death and functional deficits. This subject is described and reviewed differently in the literature. To biomedical researchers, systemic and tissue-level changes such as hemorrhage, edema, and ischemia usually define this subject. To cell and molecular biologists, "secondary injury" refers to a series of predominately molecular events and an increasingly restricted set of aberrant biochemical pathways and products. These biochemical and ionic changes are seen to lead to death of the initially compromised cells and "healthy" cells nearby through necrosis or apoptosis. This latter process is called "bystander damage." These viewpoints have largely dominated the recent literature, especially in studies of the central nervous system (CNS), often without attempts to place the molecular events in the context of progressive systemic and tissue-level changes. Here we provide a more comprehensive and inclusive discussion of this topic.
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Affiliation(s)
- Richard Ben Borgens
- Center for Paralysis Research, School of Veterinary Medicine, Department of Biomedical Engineering, Purdue University, West Lafayette, Indiana 47907, USA.
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de Heredia LL, Meagher TMM, Jamous MA, Hughes RJ. Long-term effect of MRI on sacral anterior root stimulator: the Stoke Mandeville experience. Spinal Cord 2011; 50:294-7. [PMID: 22105461 DOI: 10.1038/sc.2011.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Chandra J, Sheerin F, Lopez de Heredia L, Meagher T, King D, Belci M, Hughes RJ. MRI in acute and subacute post-traumatic spinal cord injury: pictorial review. Spinal Cord 2011; 50:2-7. [PMID: 22064660 DOI: 10.1038/sc.2011.107] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Pictorial review. OBJECTIVES To illustrate MRI signs of acute and subacute injury with emphasis on evidence-based links to clinical outcome and implications for treatment. METHODS Description of important aspects of MRI techniques and illustration of critical MRI signs important in the assessment of spinal cord injury following trauma, in the acute and subacute stages. CONCLUSIONS Familiarity with cord MRI appearances has an important impact on planning the management of the acutely spinal cord injured patient and also identifying complications in the subacute phase particularly in the presence of neurological deterioration.
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Affiliation(s)
- J Chandra
- Department of Neuroradiology, John Radcliffe Hospital, Oxford, UK
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