Zhang Jian, Wang Huili, Liu Haiying, Wang Guangshun
Number 1 Department of Orthopedic Surgery, Baodi Hospital , Tianjin, China.
Department of Spinal Surgery, Peking University People's Hospital , Beijing, China.
Spinal Cord Ser Cases. 2016 Jul 7;2:16004. doi: 10.1038/scsandc.2016.4. eCollection 2016.
To draw attention to a rare neurological deterioration after spinal cord injury (SCI) and to discuss evidence supporting an increase in cerebrospinal fluid pressure (CSFP), we present an extremely rare case of subacute post-traumatic ascending myelopathy (SPAM) in which the patient sustained a T12 fracture initially resulting in paraplegia and after undergoing posterior fixation and anterior decompression. The patient was a 32-year-old healthy man who sustained a T12 burst fracture with complete paraplegia after a fall injury. The patient underwent a posterior reduction and short-segment fixation 8 h after the injury and an anterior thoracoscopic-assisted decompression on post-traumatic day 8. On post-traumatic day 21, he had a progressive neurological deterioration with dyspnoea and decreased muscle strength of both upper extremities that could not be relieved by conservative intervention. After undergoing a cervical posterior laminectomy and durotomy, the patient exhibited the clinical manifestation of brain herniation. There was no recovery of autonomous respiration, and the patient entered a coma. The patient died on post-traumatic day 25 because of cardiac and respiratory arrest. SPAM is a rare, potentially fatal neurological deterioration after SCI; however, a prompt diagnosis can be made by magnetic resonance imaging. Our observations suggest that an increase in CSFP may be the main cause of SPAM. The paraplegic level should be recorded daily so that neurological deterioration can be recognised as soon as possible.
为引起对脊髓损伤（SCI）后罕见神经功能恶化的关注并讨论支持脑脊液压力（CSFP）升高的证据，我们报告了1例极为罕见的创伤后亚急性上升性脊髓病（SPAM）病例，该患者最初因T12骨折导致截瘫，之后接受了后路固定和前路减压术。患者为一名32岁健康男性，因坠落伤致T12爆裂骨折并完全截瘫。患者在受伤后8小时接受了后路复位和短节段固定，并于创伤后第8天接受了胸腔镜辅助前路减压术。创伤后第21天，他出现进行性神经功能恶化，伴有呼吸困难和双上肢肌力下降，保守治疗无法缓解。在接受颈椎后路椎板切除术和硬脊膜切开术后，患者出现脑疝临床表现。自主呼吸未恢复，患者陷入昏迷。患者于创伤后第25天因心搏骤停和呼吸停止死亡。SPAM是SCI后一种罕见的、可能致命的神经功能恶化；然而，磁共振成像可做出快速诊断。我们的观察结果表明，CSFP升高可能是SPAM的主要原因。应每日记录截瘫平面，以便尽早识别神经功能恶化。
