Case: A 45-year-old man presented with posttraumatic fracture-dislocation of T11/12 with neurological level T8 AIS A. Sensory level progressed to T4 in the next day morning. He underwent T10, T11, T12, and L1 percutaneous pedicle screw-rod fixation. Postoperatively, there was rapid worsening of his neurology and within 48 hours, he became tetraplegic with neurological level C2 with respiratory paralysis requiring mechanical ventilation. He died on the 14th postoperative day. Clinicoradiological findings were consistent with subacute posttraumatic ascending myelopathy (SPAM).

Conclusion: Surgeons must be vigilant in days and weeks after spinal cord injury for early recognition and management of SPAM. Treatment guidelines are uncertain and yet to be developed.