White cord syndrome: A devastating complication of spinal decompression surgery

Abstract

Background:Reperfusion injury of the spinal cord or “white cord syndrome” refers to the sudden onset of neurological deterioration after spinal decompressive surgery. Associated magnetic resonance (MR) findings only include focal hyperintensity on T2-weighted images without any other pathological changes.Case Description:A patient with cervical stenosis secondary to metastatic tumor in the intradural and extradural compartments presented with lower limb paraparesis. She underwent an uneventful tumor excision accompanied by posterior cervical decompression and fusion. Postoperatively, she was quadriplegic and required ventilator support. The emergent postoperative MR scan revealed focal hyperintensity on the T2-weighted image consistent with spinal cord edema extending into the lower brain stem.Conclusion:Very few cases of reperfusion injury of the cervical spinal cord or “white cord syndrome” are described in the literature. Here we present a patient who, following cervical laminectomy and fusion for excision of metastatic tumor, developed quadriplegia. Notably, postoperative MR showed only findings of upper cervical cord and lower brain stem edema consistent with a “white cord syndrome” without other compressive pathology.

‘White cord syndrome’, a rare but disastrous complication of transient paralysis after posterior cervical decompression for severe cervical spondylotic myelopathy and spinal stenosis: A case report

“…In the case described in the present study, signals of abnormally high intensity in the spinal cord were detected on the postoperative sagittal T2-weighted MRI scan once acute paralysis had occurred, which displayed similarities to the aforementioned cases of ‘white cord syndrome’ ( 2 , 3 , 17 , 18 ). The neurological function of the patient gradually improved with the administration of high-dose methylprednisolone therapy, according to the NASCIS-2 protocol.…”

“…Antwi et al ( 17 ) reported the case of ‘white cord syndrome’ in a 68-year-old male who had developed acute hemiparesis on the left side following C4-C7 posterior laminectomy decompression in 2018. Also in 2018, Vinodh et al ( 3 ) reported similar findings in a 51-year-old female who was diagnosed with a metastatic intraspinal tumor and presented with quadriplegia following posterior cervical laminectomy and fusion for tumor resection. Papaioannou et al ( 18 ) reported the case of ‘white cord syndrome’ in a 79-year old male who had undergone C4-C6 ACDF 2 years previously because of cervical spondylotic myelopathy.…”

“…Furthermore, intraoperative neurophysiological monitoring is an effective tool to evaluate SSEP and MEP alterations, and to indicate whether spinal cord injury has occurred during surgery ( 23 ). Finally, posterior cervical laminectomies were performed in all reported cases of ‘white cord syndrome’ following posterior decompression surgery ( 3 , 17 , 18 ), including the present case report. In all cases, it may be recommended to opt for posterior cervical laminoplasty instead of posterior cervical laminectomy to avoid excessive expansion of the spinal cord and to reduce the risk of ischemia-reperfusion injury.…”

“…Spinal cord ischemia-reperfusion injury has been confirmed as a potential etiology of the associated neurological deterioration. Spinal cord ischemia-reperfusion injury is defined as the sudden expansion of the compressed cord and exposure to a rush in blood supply following decompression surgery, which leads to disruption of the blood-brain barrier and blood-spinal cord barrier, and may ultimately result in acute neurologic dysfunction ( 2 , 3 ). The reported incidence rate of spinal cord ischemia-reperfusion injury following cervical decompression surgery ranges from 2-5.7%, but a higher incidence rate of 14.5% has been reported for posterior decompressive laminectomy procedures used for thoracic spinal stenosis ( 4 , 5 ).…”

A case report: white cord syndrome following anterior cervical discectomy and fusion: importance of prompt diagnosis and treatment

“…This paraplegia is reported to be mostly caused by hematoma or iatrogenic injury. However, there is paraplegia that cannot be explained by these things, which can be caused by reperfusion injury, so called 'white cord syndrome' [1]. White cord syndrome is extremely rare and search of the literature has revealed very few cases.…”