Recurrent transverse myelitis after lumbar spine surgery: a case report

Abstract

Study design: A case of recurrent idiopathic transverse myelitis occurring after surgery is reported.

Objectives: To present a case of idiopathic transverse myelitis recurring after surgery and to heighten awareness for the diagnosis and management of this disorder.

Summary and background data: Transverse myelitis presenting with acute spinal pain and neurologic deficit must be considered along with structural causes of myelopathy by the spine specialist. This intramedullary spinal cord disorder may be caused by parainfectious and postvaccinal sequelae, multiple sclerosis, spinal cord ischemia, autoimmune disorders, and paraneoplastic syndromes. These various etiologies are often difficult to differentiate. However, a patient's history, clinical course, MRI studies, and laboratory findings often allow such classification. Determination of etiology provides pertinent information regarding potential recurrence, treatment, and prognosis.

Methods: The patient history, physical examination, radiologic and laboratory studies, and pertinent literature were reviewed.

Results: Thoracolumbar myelitis developed in the reported patient 6 weeks after lumbar spine surgery during an otherwise uncomplicated postoperative recovery. The workup did not identify a specific cause, and the patient recovered to ambulatory status. However, 4 months after surgery, acute transverse myelitis developed again, this time affecting the cervical spinal cord. Despite aggressive intervention with corticosteroids, the patient has remained nonambulatory with severe neurologic residua. In spite of an extensive workup, a definitive cause was not determined, although an autoimmune etiology was suspected. The patient has stabilized without recurrence using immunosuppressant therapies.

Conclusions: Acute transverse myelitis is an intramedullary spinal cord disorder that may present to the spine specialist during the postoperative period. This diagnosis requires swift and aggressive diagnostic and treatment intervention. Although sometimes difficult, establishment of causation may help to determine therapy and prognosis.