PMC6786435_01
The neurologic status as per ASIA/ISCoS-ISNCSCI (American Spinal Injury Association/International Spinal Cord Society-International Standards for Neurological Classification of Spinal Cord Injury). a At the time of earlier presentation with symptoms of cervical myelopathy 2 years ago. b At 1 year follow up period after surgery for cervical myelopathy by posterior instrumentation C1-T1 and C1 to C7 decompression along with foramen magnum decompression. c At the time of presentation with symptoms of thoracic myelopathy. d At 2 weeks post surgery for thoracic myelopathy by posterior instrumented fusion from T9 to L2 vertebrae and decompression T11-T12
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Fig1
Her neurologic status at that time of presentation was attached in Fig. 1a according to the ASIA/ISCoS-ISNCSCI (American Spinal Injury Association/International Spinal Cord Society-International Standards for Neurological Classification of Spinal Cord Injury). She had a good outcome with an improvement of symptoms and regained the ability to walk without support (Fig. 1b). The neurologic status was as attached in Fig. 1c. The weakness gradually progressed from ninth postoperative day resulting in complete paraplegia (neurological level T8) with completely absent perianal sensation and voluntary anal contraction by fourteenth postoperative day (Fig. 1d).
Preoperative sagittal (a) and axial (b) T2 MRI images of the patient's thoracolumbar spine suggestive of a discovertebral lesion at T11-T12 with instability with cord edema at the level of the lesion. Preoperative T2 MRI screening of the whole spine (c) showing no lesion above and below the area of interest
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Fig2
It revealed a three-column Anderson-like lesion at T11-T12 level with cord edema behind T11 vertebra suggestive of dynamic cord compression (Fig. 2).
Postoperative sagittal (a) and axial (b) T2 MRI images of the thoracolumbar spine taken 2 days after surgery show no extension of edema. Artifacts were caused by the pedicle screw and rod instrumentation used for stabilization. Postoperative X-rays (c) of the patient's thoracolumbar spine showing proper placement of screws and stabilization of the lesion. CT scan (d) of the thoracolumbar spine was obtained to exclude possible spinal canal compromise by the instrumentation
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Fig3
Pregabalin was increased gradually. Postoperative MRI revealed an adequately decompressed cord (Fig. 3a, b). Radiographs and CT scan demonstrated a stable fixation (Fig. 3c, d).
Sagittal (a) and axial (b, c) postoperative T2 MRI images of the patient's thoracolumbar spine taken 2 weeks after surgery showing the extension of edema (marked by blue arrow) up to T7 level. Artifacts are caused by the pedicle screw and rod instrumentation used for stabilization
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Fig4
Repeat MRI revealed hyper-intense signal changes extending five levels above the index level (up to T7 vertebra) but no static compression or instability at the index level (Fig. 4).
Sagittal (a) and axial (b) T2 images of MRI of the patient's thoracolumbar spine taken 3 months after surgery showing the persistence of edema (marked by blue arrow) till T7 level
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Fig5
MRI was repeated at 6 weeks and 3 months post surgery, which suggested persistent edema till T7 vertebral level (Fig. 5).