1233 - Subacute Post-traumatic Ascending Myelopathy (SPAM): A Case Report

Case Diagnosis:
The patient was diagnosed with subacute post-traumatic ascending myelopathy (SPAM).

Case Description: A 45-year-old male with no prior medical history presented to the emergency department after being struck by a vehicle. In the trauma bay he was in hemorrhagic shock and required multiple transfusions. Workup revealed an open book pelvic fracture, occipital condyle fracture, right C6 and C7 transverse process fractures, L2 vertebral body, and transverse process fracture with hemorrhagic spinal cord contusion from T2-T6. On hospital day 6, the patient underwent anterior pelvic external fixation, open reduction of T3-T4 fractures, and posterior thoracic fusion of T2-6. He was extubated on hospital day 10 and subsequently reintubated for worsening respiratory status on day 13. He developed fevers and was treated for Pseudomonas pneumonia. His hospital course was further complicated by extubation failure and ultimately required a tracheostomy. On hospital day 24, the patient had worsening upper extremity strength. MRI of the cervical spine found extensive T2/STIR signal from C5-T2.

Discussions: SPAM is a rare sequela of traumatic spinal cord injury that develops within the first few weeks and is characterized by neurological deterioration involving four or more vertebral segments above the initial site of injury. Our patient was initially graded an ISNCSCI T1 AIS A and declined to C4 AIS A. Our case demonstrates the medical complexity and factors such as sedation, sepsis, and respiratory failure that may delay diagnosis. Moreover, less is known regarding the pathophysiology of such conditions and the treatment to prevent the progression apart from supportive care.

Conclusions: Physiatrists should be aware of the development of such life threatening sequelae after traumatic spinal cord injury, the clinical course, and imaging findings.