Subacute Posttraumatic Ascending Myelopathy After an Incomplete Spinal Cord Injury from a Gunshot Wound to the Spine: Case Report and Review of the Literature.

Abstract

Subacute posttraumatic ascending myelopathy (SPAM) is a rare event that occurs after spinal cord trauma or ischemia. SPAM is defined as progressive loss of spinal cord or nerve root function days to weeks after the initial trauma that cannot be attributed to mechanical instability. Because of the rarity of this condition, there is no clear understanding of its cause, natural history, or treatment guidelines for patient management. Here, we present the first reported case of SPAM after a gunshot wound to the spine. In this case, the patient presented with a mild spinal cord injury that recovered after surgery but then progressed to a more severe spinal cord injury many days later. Magnetic resonance imaging before and after his new symptoms supported the diagnosis of SPAM. This case demonstrates that spinal cord injury is a dynamic lesion, both in the immediate postinjury stage and in the subacute time interval as well. This is the first reported case of SPAM that occurred after the resolution of incomplete SCI and only the second that occurred after a gunshot wound.