Late postoperative myelomalacic myelopathy.

Area of Science:

• Neurosurgery
• Neurology
• Spine Surgery

Background:

• Spinal cord atrophy with late progressive myelopathy after cervical spine surgery is rare and poorly understood.
• This phenomenon can occur years after initial clinical stability post-surgery.

Observation:

• Two patients developed insidious, chronic progressive myelopathy over a decade after cervical ependymoma removal and craniocervical fusion.
• Initial symptoms appeared after years of stability, leading to significant myelopathy and dependency.

Findings:

• Extensive investigations ruled out common causes like arachnoid adhesions, tumor recurrence, instability, trauma, syringomyelia, radiotherapy, or infectious/demyelinating diseases.
• The patients' conditions progressed despite the absence of identifiable etiologies.

Implications:

• Late neurological deterioration following cervical spine surgery may occur without identifiable causes or complications.
• Further research is needed to understand the mechanisms behind unexplained late myelopathy after spinal surgery.