Evaluation of corticosteroid treatment in patients with post-traumatic ascending myelopathy and spinal cord injury: three case reports and review of the literature.

Abstract

Introduction: Subacute post-traumatic ascending myelopathy (SPAM) is defined as a neurological deterioration extending several levels above the initial spinal cord injury (SCI) within the first few weeks post-injury, without associated mechanical instability or syringomyelia. This report details three cases of SPAM to highlight this condition.

Cases presentation: We present three case reports who sustained SPAM over the last 7 years at the Hospital Universitari Vall d'Hebron in Barcelona (Spain). The first patient was a 41-year-old male with a traumatic C5 SCI (AIS A), diagnosed of SPAM 35 days post-injury with a C3 SCI (AIS A) and treated with descending taper of dexamethasone (Dx). The second patient was a 45-year-old female with a traumatic C7 SCI (AIS A), diagnosed of SPAM 39 days post-injury with a C4 SCI (AIS A) and treated with a 3-day methylprednisolone (MP) bolus. The third patient was a 40-year-old male with a traumatic T7 SCI (AIS B), diagnosed of SPAM 11 days post-injury with a T5 SCI (AIS A) and treated with a 7-day MP bolus. The third patient showed improvement in AIS classification. A literature review of identification and treatment of SPAM was conducted.

Discussion: SPAM is a severe and rare complication that should be considered within weeks following an acute traumatic SCI. There is no consensus in the literature regarding the treatment of corticosteroids related to SPAM. In the three cases presented, methylprednisolone was associated with better outcomes than dexamethasone; however, given the small sample size, this observation remains preliminary and hypothesis-generating.