Academic Neurosurgery Unit, Molecular & Clinical Science Research Institute, St George's, University of London, London, UK.
Spinal Treatment Centre, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, UK.
Br J Neurosurg. 2022 Dec;36(6):792-795. doi: 10.1080/02688697.2022.2102146. Epub 2022 Jul 22.
We describe a novel progressive neurological syndrome complicating traumatic spinal cord injury (TSCI). Based on clinical and radiological features, we propose the term 'Chronic Relapsing Ascending Myelopathy' (CRAM). We distinguish between the previously described sub-acute progressive ascending myelopathy (SPAM) and post-traumatic syringomyelia (PTS), which may lie on a spectrum with CRAM.
A 60-year-old man sustained a T4 ASIA-A complete TSCI. Four months post-injury, he developed a rapidly progressive ascending sensory level to C4. Clinical and radiological evaluation revealed ascending myelopathy with progressive T2 hyper-intense cord signal change. He underwent cord detethering and expansion duroplasty. Following an initial dramatic resolution of symptoms, the patient sustained two relapses, each 1-month post-discharge characterised by recurrence of disabling ascending sensory changes, each correlating with the radiological recurrence of cord signal change. Symptoms and radiological signal change permanently resolved with more extensive detethering and expansion duroplasty. There is radiological and clinical resolution at 1-year follow-up.
Acute neurological deterioration post-TSCI may be due to SPAM or may occur after years due to PTS. We propose CRAM as a previously unrecognised phenomenon. The radiological characteristics overlap with SPAM. However, CRAM presents later and, clinically, behaves like PTS, but without cord cystic change. Cord detethering with expansion duroplasty are an effective treatment.
我们描述了一种复杂于外伤性脊髓损伤（TSCI）的新型进行性神经综合征。基于临床和影像学特征，我们提出了“慢性复发性上升性脊髓病”（CRAM）这一术语。我们将其与先前描述的亚急性进行性上升性脊髓病（SPAM）和创伤后脊髓空洞症（PTS）区分开来，这两者可能与 CRAM 存在一定的关联。
一位 60 岁男性，T4 ASIA-A 型完全性 TSCI。受伤后 4 个月，他出现了迅速进展的上升性感觉水平至 C4。临床和影像学评估显示上升性脊髓病，伴有进行性 T2 高信号脊髓信号改变。他接受了脊髓松解和扩张性硬脑膜成形术。在最初症状明显缓解后，患者经历了两次复发，每次复发都在出院后 1 个月，表现为进行性的、致残性的上升性感觉改变，每次复发都与脊髓信号改变的影像学复发相关。通过更广泛的脊髓松解和扩张性硬脑膜成形术，症状和影像学信号改变永久性地得到了缓解。在 1 年的随访中，患者的情况得到了明显改善。
TSCI 后的急性神经恶化可能是由于 SPAM 引起的，也可能在数年后由于 PTS 引起。我们提出 CRAM 作为一种以前未被识别的现象。其影像学特征与 SPAM 重叠。然而，CRAM 发病较晚，临床表现类似于 PTS，但没有脊髓囊状改变。脊髓松解和扩张性硬脑膜成形术是一种有效的治疗方法。
