Ascending myelopathy in the early stage of spinal cord injury

A 30-year-old healthy woman was involved in a road traffic accident. She su stained a fracture dislocation of T11/12 with a complete Frankel A parapleg ia below T11, She had no associated injuries. High Dose Methylprednisolone was administered according to the NASCIS III protocol (48 h) together with low molecular weight Heparin and gastroprotected medication. Complete trans ection of the spinal cord and an anterior haematoma from T11 to T12 were co nfirmed on X rays, CT's and MRI scans. Posterior surgical stabilisation was performed using Isola instrumentation, starting 8 h post injury. Her post surgical period was uneventful except for some episodes of low blood pressu re (85/60 mmHg) from which she had no symptoms. On the 12th post operative day, while in the physiotherapy department, she complained of right scapula r pain. This occurred every time she was sat up and was associated with par aesthesia of both upper limbs. Two days later she deteriorated neurological ly and her level ascended initially to T8 and then to T3. MRI of the spine with and without gadolinium showed spinal cord oedema between C3 and T1, Th ere was no evidence of haemorrhage or syringomyelia, The authors discussed this case making different hypotheses. They are mainly the following: (1) G radually ascending ischaemia due to a vascular disorder; (2) Double spinal trauma; (3) Ischaemia related to repeated hypotensive episodes; (4) Low gra de intramedullary tumour; and (5) Thrombus of the Radicularis Magna artery. The case has been recognised as being very rare and interesting. In the co nclusions, the presenting author stresses the importance of adopting MRI-co mpatible instrumentation for the surgical stabilisation of the spine, and c areful monitoring of blood pressure during the acute phase of spinal cord i njury. Dr Aito agrees with Mr E1 Masry about the opportunity of forming a g roup of clinicians in order to discuss protocols to cope with this devastat ing complication.