Subacute post-traumatic ascending myelopathy after cervical spinal cord injury: a rare and fatal complication

Subacute post-traumatic ascending myelopathy (SPAM) is a rare but devastating complication of spinal cord injury (SCI). It is character-ized by progressive neurological deterioration extending several segments above the primary lesion within days to weeks after trauma. The underlying pathophysiology remains uncertain, and treatment strategies are not standardized. A 38-year-old man sustained trau-matic C6-7 spondylolisthesis with bilateral facet dislocation following a motorcycle accident. Initial magnetic resonance imaging (MRI) demonstrated cord contusion and edema extending from C5 to C7. After traction and reduction, the patient underwent anterior C6 corpectomy with placement of an expandable cage and C5-7 plating, followed by C5-6 total laminectomy and C4-7 posterior in-strumentation. Postoperatively, partial neurological recovery was observed. However, on postoperative day 10, the patient developed quadriparesis rapidly progressing to quadriplegia, accompanied by spinal shock and respiratory failure requiring mechanical ventilation. Imaging studies excluded hematoma and implant failure, although postoperative MRI was limited by metallic artifacts. Differential diagnoses, including pulmonary embolism, cardiac dysfunction, and sepsis, were ruled out. Based on the clinical progression and exclu-sion of alternative causes, a diagnosis of ascending myelopathy was established. Despite intensive supportive care, the patient died on the fourth day of mechanical ventilation. SPAM remains an unpredictable and fatal complication of SCI. Limitations in postoperative imaging, particularly metal-related artifacts, may hinder diagnosis, underscoring the importance of correlating clinical and radiological findings. Vigilant monitoring and continued reporting of cases are essential to improve recognition, refine diagnostic strategies, and guide management of this rare entity.