title: Late postoperative myelomalacic myelopathy.
abstract: METHODS
  This is a case report.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 1] Department of Neurosurgery, Centro Hospitalar de São João, Porto, Portugal [2] Faculty of Medicine of the University of Porto, Porto, Portugal.
authors.forename: B
authors.initials: B
authors.lastname: de Carvalho
authors.affiliation: Department of Neurology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal.
authors.forename: P
authors.initials: P
authors.lastname: Barros
authors.affiliation: 1] Department of Neurosurgery, Centro Hospitalar de São João, Porto, Portugal [2] Faculty of Medicine of the University of Porto, Porto, Portugal [3] Neurosciences Department, Hospital CUF Porto, Porto, Portugal.
authors.forename: P
authors.initials: P
authors.lastname: Pereira
authors.affiliation: 1] Department of Neurosurgery, Centro Hospitalar de São João, Porto, Portugal [2] Faculty of Medicine of the University of Porto, Porto, Portugal [3] Neurosciences Department, Hospital CUF Porto, Porto, Portugal.
authors.forename: R
authors.initials: R
authors.lastname: Vaz
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D011183:Postoperative Complications / Q000503:physiopathology*; D013120:Spinal Cord Neoplasms / Q000209:etiology*