Abstract
Study design:
This is a case report.
Objectives:
Spinal cord atrophy presenting with late progressive myelopathy after many years of clinical stability is a rare and unexplained phenomenon after cervical spine surgery. The authors report and discuss the etiologies and outcomes of late postoperative myelomalacic myelopathy.
Setting:
This study was conducted in the Department of Neurosurgery, Centro Hospitalar S. João, Porto, Portugal.
Methods:
We report on two patients with insidious chronic progressive myelopathy that developed more than 10 years after complete removal of a cervical intramedullary ependymoma and after transoral odontoidectomy and occipitocervical fusion for craniocervical junction malformation. Differential diagnoses were formulated and review of the literature was performed.
Results:
In both patients, after several years of clinical stability, insidious onset of debilitating myelopathy and dependency ensued. The clinical history, serology, imaging and neurophysiological investigation excluded several putative etiologies: arachnoid adhesions, tumor recurrence, late vertebral instability, trauma, syringomyelia, radiotherapy, and demyelinating or infectious causes.
Conclusion:
Late neurological deterioration after cervical spine surgery is usually related to disease progression or surgery-related complications. Nevertheless, in some patients late myelopathy can ensue even in the absence of identified causes.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Eroes CA, Zausinger S, Kreth FW, Goldbrunner R, Tonn JC . Intramedullary low grade astrocytoma and ependymoma. Surgical results and predicting factors for clinical outcome. Acta Neurochir 2010; 152: 611–618.
Winegar CD, Lawrence JP, Friel BC, Fernandez C, Hong J, Maltenfort M et al. A systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine 2010; 13: 5–16.
Jeffery DR . Chronic progressive myelopathy: diagnostic analysis of cases with and without sensory involvement. J Neurol Sci 1996; 142: 153–156.
Cooper PR . Outcome after operative treatment of intramedullary spinal cord tumors in adults: intermediate and long-term results in 51 patients. Neurosurgery 1989; 25: 855–859.
Garces-Ambrossi GL, McGirt MJ, Mehta VA, Sciubba DM, Witham TF, Bydon A et al. Factors associated with progression-free survival and long-term neurological outcome after resection of intramedullary spinal cord tumors: analysis of 101 consecutive cases. J Neurosurg Spine 2009; 11: 591–599.
Brotchi J, Fischer G . Spinal cord ependymomas. Neurosurg Focus 1998; 4: e2.
Raco A, Esposito V, Lenzi J, Piccirilli M, Delfini R, Cantore G . Long-term follow-up of intramedullary spinal cord tumors: a series of 202 cases. Neurosurgery 2005; 56: 972–981.
Hoshimaru M, Koyama T, Hashimoto N, Kikuchi H . Results of microsurgical treatment for intramedullary spinal cord ependymomas: analysis of 36 cases. Neurosurgery 1999; 44: 264–269.
Samii M, Klekamp J . Surgical results of 100 intramedullary tumors in relation to accompanying syringomyelia. Neurosurgery 1994; 35: 865–873.
Deutsch H, Haid RW, Rodts GE, Mummaneni PV . Occipitocervical fixation: long-term results. Spine 2005; 30: 530–535.
Avrahami E, Tadmor R, Cohn DF . Magnetic resonance imaging in patients with progressive myelopathy following spinal surgery. J Neurol Neurosurg Psychiatry 1989; 52: 176–181.
Finsterer J, Lubec D, Samec P . Generalised spinal cord atrophy, Chiari-I malformation, and syringomyelia. Spinal Cord 2001; 39: 184–188.
Shimizu K, Nakamura M, Nishikawa Y, Hijikata S, Chiba K, Toyama Y . Spinal kyphosis causes demyelination and neuronal loss in the spinal cord: a new model of kyphotic deformity using juvenile Japanese small game fowls. Spine 2005; 30: 2388–2392.
Acknowledgements
We thank Dr. Ricardo Cardoso for professional language editing.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Competing interests
The authors declare no conflict of interest.
Rights and permissions
About this article
Cite this article
de Carvalho, B., Barros, P., Pereira, P. et al. Late postoperative myelomalacic myelopathy. Spinal Cord 53 (Suppl 1), S27–S29 (2015). https://doi.org/10.1038/sc.2014.239
Received:
Revised:
Accepted:
Published:
Issue date:
DOI: https://doi.org/10.1038/sc.2014.239
