{"id":"a1596bd5-8d25-45db-9500-98d47644f7fc","slug":"silent-ascent-of-injury-cervical-cord-involvement-in-subacute-posttraumatic-ascending-myelopathy","title":"Silent ascent of injury: Cervical cord involvement in subacute posttraumatic ascending myelopathy","authors":["Hamza Shaikh","Aditya Chouhan"],"abstract":"Background: Subacute posttraumatic ascending myelopathy (SPAM) is a rare but serious complication of spinal cord injury (SCI). It is extremely unusual for a thoracolumbar fracture to cause an ascending injury to the cervical cord, creating significant diagnostic and therapeutic challenges. Case Description: A 26-year-old male suffered an L1 unstable burst fracture with complete paraplegia (American Spinal Injury Association A) following a motor vehicle accident. He underwent posterior decompression with short-segment D12-L2 fixation. After an initial uneventful recovery, he acutely deteriorated on the 7 th postoperative day, now demonstrating new left upper limb/trunk paresis with accompanying sensory loss over the anterolateral aspect of the left forearm and bilateral hand. The immediate magnetic resonance imaging (MRI) demonstrated extensive C3-C4 to D12 spinal cord edema consistent with subacute posttraumatic ascending myelopathy (SPAM); it was treated with high-dose intravenous methylprednisolone. One month later, he had partially recovered left upper limb strength, but lower extremity plegia remained (i.e., unchanged up to the 9-month follow-up). Conclusion: SPAM is a rare but potentially life-threatening complication following SCI that is characterized by rapid neurological decline. Early recognition utilizing timely MRI is essential to determining optimal management strategies that may vary from high-dose steroids to additional surgical intervention.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/sni-17-382/figures/SNI-17-382-g001.jpg","publishDate":"2026-07-03T00:00:00.000Z","doi":"10.25259/SNI_467_2026","categories":["Spine","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/a1596bd5-8d25-45db-9500-98d47644f7fc/pdf"}