We are glad to hear that Dr Miller & Dr Ahmad show great interest in our review: Subacute post-traumatic ascending myelopathy: a literature review.1

As many articles have mentioned, subacute post-traumatic ascending myelopathy (SPAM) is defined as neurological deterioration involving four or more vertebral segments above the initial injured site within the first few weeks. In our case, we suspect that a durotomy was indicated for improving respiratory failure caused by ascending myelopathy. Our purpose for reporting is just to remind the readers that SPAM is life-threatening and difficult to treat.

In the case from Dr Miller & Dr Ahmad, SPAM developed in a young man after mild spinal cord injury by gunshot,1 which is similar to Dr Visocchi’s case who had no neurological dysfunction after a neck gunshot injury, but unfortunately neurological deterioration occurred after 9 h.2 A different mechanism of injury may exist in gunshot injury.