Subacute Delayed Ascending Myelopathy after Spinal Cord Injury from Flexion-distraction Injury of Low Thoracic Spine - A Case Report -

Sang Jae Park; Jae Hwan Cho; Sang Ik Shin; Bong-Soon Chang; Choon-Ki Lee

doi:10.4184/jkss.2013.20.3.123

Journal List > J Korean Soc Spine Surg > v.20(3) > 1075991

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Park, Cho, Shin, Chang, and Lee: Subacute Delayed Ascending Myelopathy after Spinal Cord Injury from Flexion-distraction Injury of Low Thoracic Spine - A Case Report -

Case Report

Journal of Korean Spine Surg 2013;20(3):123-128.

Published online: 21 September 2013

DOI: https://doi.org/10.4184/jkss.2013.20.3.123

Subacute Delayed Ascending Myelopathy after Spinal Cord Injury from Flexion-distraction Injury of Low Thoracic Spine - A Case Report -

Sang Jae Park, M.D., Jae Hwan Cho, M.D., Sang Ik Shin, M.D., Bong-Soon Chang, M.D., Choon-Ki Lee, M.D.

Department of Orthopedic Surgery, Seoul National University College of Medicine

Corresponding author: Bong-Soon Chang, M.D. Department of Orthopedic Surgery, Seoul National University Hospital, Dae-hak-ro 101, Jongno-gu, Seoul, Korea TEL: 82-2-2072-3864, FAX: 82-2-764-2718 E-mail: bschang@snu.ac.kr

Received 20 February 2012 Revised 13 April 2012 Accepted 18 October 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A case report.

Objectives

To report a rare case of subacute delayed ascending myelopathy.

Summary of Literature Review

After low spinal cord injury, the cord injury may proceed to a proximal level and lead to subacute delayed ascending myelopathy. The patient suffered from orthostatic hypotension, weakness and sensory loss in the upper extremities and dyspnea. MRI showed more proximal progression of the spinal cord injury. There is no prevention or treatment for this condition.

Materials and Methods

A 62-year-old man fell from heights and had 11th thoracic spine flexion-distraction injury. Upon arrival at the hospital, he was found to suffer from lower extremity weakness and sensory loss, but showed no neurologic symptom in his upper extremities. Two days later, we performed posterior instrumentation with fusion, and no postoperative neurologic symptom change was detected. One week after the fall, he suffered from dyspnea, upper extremity weakness and sensory loss. MRI was taken and we discovered that his spinal cord injury had proceeded to the 2nd cervical spine level.

Results

Three months later, he showed little improvement in his upper extremity motor power, but not to the extent of the previous low spinal injury.

Conclusion

Physicians should pay attention to the upper extremity and respiratory function of the patient with low spinal cord injury, because the level of spinal cord injury may proceed to a proximal level.

Keywords: Subacute delayed ascending myelopathy, Low thoracic spine, Spinal cord injury

REFERENCES

1. Schmidt BJ. Subacute delayed ascending myelopathy after low spine injury: case report and evidence of a vascular mechanism. Spinal Cord. 2006; 44:322–5.

2. Belanger E, Picard C, Lacerte D, Lavallee P, Levi AD. Subacute posttraumatic ascending myelopathy after spinal cord injury. Report of three cases. J Neurosurgery. 2000; 93:294–9.

3. Aito S, El Masry WS, Gerner HJ, et al. Ascending myelopathy in the early stage of spinal cord injury. Spinal Cord. 1999; 37:617–23.

4. Tator CH, Fehlings MG. Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. J Neurosurgery. 1991; 75:15–26.

5. Sliwa JA, Maclean IC. Ischemic myelopathy: a review of spinal vasculature and related clinical syndromes. Arch Phys Med Rehabil. 1992; 73:365–72.

6. Cassar-Pullicino VN, Colhoun E, McLelland M, Mc-Call IW, el Masry W. Hemodynamic alterations in the paravertebral venous plexus after spinal injury. Radiology. 1995; 197:659–63.

7. Frankel HL. Ascending cord lesions in the early stages following spinal injury. Paraplegia. 1969; 7:111–8.

8. Kumar A, Kumar J, Garg M, Farooque K, Gamanagatti S, Sharma V. Posttraumatic subacute ascending myelopathy in a 24-year-old male patient. Emerg Radiol. 2010; 17:249–52.

Fig. 1.

(A, B) Plain radiograph of D-L spine AP and Lateral. Showing T11 body and left pedicle, L2 body fracture

Fig. 2.

Axial MRI of T10-11 spine, showing T11 left pedicle fracture

Fig. 3.

Sagittal T1 MRI of D-L spine. Showing T11, T12 and L2 body fracture

Fig. 4.

Sagittal T2 MRI of D-L spine. Showing increased signal intensity from T5 to T12.

Fig. 5.

Sagittal CT of C-spine. Showing no fracture

Fig. 6.

(A, B) Plain radiograph of D-L spine AP and lateral. Showing Posterior instrumentation from T9 to L1, Kyphoplasty L2.

Fig. 7.

Sagittal T2 MRI of C-spine. Showing increased signal intensity of spinal cord from C2 to distal

Fig. 8.

Sagittal T2 MRI of T-spine. Showing increased signal intensity of spinal cord from fracture site.

TOOLS

Similar articles