1103 - Climbing the Cord: Subacute Post-Traumatic Ascending Myelopathy After a Cervical Fracture Dislocation - a Case Report

A 36-year-old male presented after striking his head on a water slide. He reported a cape-like burning sensation in his upper extremities, inability to move his lower extremities, and absent rectal tone, consistent with an AIS A complete injury. Imaging revealed a C6–C7 fracture dislocation with complete anterior migration of C6, spinal canal obliteration, and cord hemorrhage from C4–C7. Emergent anterior cervical discectomy and fusion achieved partial reduction and canal realignment. Postoperatively, he was admitted to the ICU and transferred to inpatient rehabilitation on postoperative day 14. He progressed well until postoperative day 34, when he developed worsening neck and shoulder pain, sensory changes at C6, and urinary incontinence. MRI showed resolution of canal stenosis but new cord edema from C2–C7, consistent with SPAM. High-dose dexamethasone was initiated with symptom improvement.

Discussions: SPAM is a rare complication of spinal cord injury. SPAM is defined as neurological deterioration ascending ≥4 spinal segments within days to weeks, without recurrent instability or compression. Most cases occur in men, often after thoracic injury. Proposed mechanisms include venous congestion, arterial compromise, reperfusion injury, inflammation, and multifactorial processes. Patients may develop new weakness, sensory deficits, or neuropathic pain above the injury level, often preceded by neck, shoulder, or arm pain. MRI is the gold standard, revealing rostral T2 hyperintensity and cord edema. In this patient, progression to C2–C7 despite stable alignment supports a vascular-inflammatory process rather than mechanical injury. Corticosteroids may stabilize symptoms though prognosis is poor.

Conclusions: SPAM should be suspected in patients with delayed neurological decline after SCI despite adequate decompression. MRI allows early detection and exclusion of recurrent compression. Early recognition during the subacute period is crucial to guide supportive care, symptom management, and optimize functional outcomes.