Silent ascent of injury: Cervical cord involvement in subacute posttraumatic ascending myelopathy

Subacute posttraumatic ascending myelopathy (SPAM) is a rare but serious complication of spinal cord injury (SCI). It is extremely unusual for a thoracolumbar fracture to cause an ascending injury to the cervical cord, creating significant diagnostic and therapeutic challenges.

A 26-year-old male suffered an L1 unstable burst fracture with complete paraplegia (American Spinal Injury Association A) following a motor vehicle accident. He underwent posterior decompression with short-segment D12-L2 fixation. After an initial uneventful recovery, he acutely deteriorated on the 7^th postoperative day, now demonstrating new left upper limb/trunk paresis with accompanying sensory loss over the anterolateral aspect of the left forearm and bilateral hand. The immediate magnetic resonance imaging (MRI) demonstrated extensive C3-C4 to D12 spinal cord edema consistent with subacute posttraumatic ascending myelopathy (SPAM); it was treated with high-dose intravenous methylprednisolone. One month later, he had partially recovered left upper limb strength, but lower extremity plegia remained (i.e., unchanged up to the 9-month follow-up).

SPAM is a rare but potentially life-threatening complication following SCI that is characterized by rapid neurological decline. Early recognition utilizing timely MRI is essential to determining optimal management strategies that may vary from high-dose steroids to additional surgical intervention.