White Cord Syndrome After Cervical or Thoracic Spinal Cord Decompression. Hemodynamic Complication or Mechanical Damage? An Underestimated Nosographic Entity

Gerardi, Rosa Maria; Giammalva, Giuseppe Roberto; Basile, Luigi; Gulì, Carlo; Pino, Maria Angela; Messina, D; Umana, Giuseppe Emmanuele; Graziano, Francesca; Bonaventura, Rina Di; Sturiale, Carmelo Lucio; Visocchi, Massimiliano; Iacopino, Domenico Gerardo; Maugeri, Rosario

doi:10.1016/j.wneu.2022.05.012

Cited by 7 publications

(5 citation statements)

References 51 publications

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“…The signals showed similar MRI exhibitions as those in “White Cord Syndrome (WCS) patients”. Realizing the real WCS entity refers to a rare pathologic condition that affects patients experiencing an unexplained neurologic deficit after spine surgery who exhibited normal intramedullary MRI signals preoperatively ( 29 ). Our case gained complete neurologic recovery 3 months postoperatively, meanwhile the pre-existing hyperintense T2WI MRI images did not expand at final MRI re-examination, we do not think our patient belonged to a WCS one.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of thoracic myelopathy caused by spontaneous spinal epidural hematoma (SSEH) combined with calcification of the ligamentum flavum (CLF) by posterior percutaneous endoscopic surgery (PPES): A case report

et al. 2023

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Study DesignA retrospective case report.ObjectiveTo report a case who developed deteriorated paraplegia by spontaneous spinal epidural hematoma (SSEH) based on calcification of the ligamentum flavum (CLF) at the T10–11 level, achieved full neurological recovery following posterior percutaneous endoscopic surgery (PPES).Summary of Background DataCLF rarely occurs at the thoracic spine, and the symptom usually progress slowly. SSEH is another rare spinal lesion that might progress rapidly and cause emergent severe spinal cord compression syndrome. Coexistence of SSEH and CLF at the same thoracic level was rarely reported in English literature.MethodsA 65-year-old man presented to our hospital with the complaint of sensorimotor loss on the lower limbs and dysfunction of bladder for 1 day after a progressive weakness and numbness of the lower limbs for 3 months. MR examination found a dorsal protruding mass at the T10–11 level, while computed tomography (CT) found the protruding mass contained scattered calcified deposits. The patient was diagnosed with thoracic CLF. Decompression via PPES was carried out to realize bilateral decompression through a unilateral approach.ResultsDuring the operation, the protruding mass was found to be composed of SSEH and CLF together. After the operation, the patient's neurological function recovered quickly. One week later, the patient could walk by himself. After 3 months, complete neurological function had recovered.ConclusionSSEH could develop based on CLF at thoracic level and cause serious neurological dysfunction. PPES might be an advisable method to remove CLF and evacuate SSEH with good clinical results.

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Section: Discussionmentioning

confidence: 99%

Successful treatment of thoracic myelopathy caused by spontaneous spinal epidural hematoma (SSEH) combined with calcification of the ligamentum flavum (CLF) by posterior percutaneous endoscopic surgery (PPES): A case report

et al. 2023

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“…WCS is uncommon after cervical or thoracic spinal decompression surgery but potentially devastating (4). WCS is a possible explanation for delayed deterioration with no cause identified (5).…”

Section: Discussionmentioning

confidence: 99%

Case report: Medulla oblongata and cervical cord reperfusion injury after intracranial vertebral artery angioplasty and stenting

et al. 2023

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BackgroundWhite cord syndrome is an uncommon complication characterized by delayed neurologic deterioration with no other identified cause after spinal decompression surgery. Its etiology is attributed to spinal cord reperfusion injury. Here, we present the first case of an extended version of white cord syndrome, with concomitant involvement of the medulla oblongata and cervical cord reperfusion injury after intracranial vertebral artery angioplasty and stenting.Case presentationA 56-year-old male suffered an ischemic stroke in the right anteromedial medulla oblongata. Angiography revealed bilateral vertebral artery stenosis in the intracranial segment. We performed elective left vertebral artery angioplasty and stenting. An intraoperative flow arrest in the left VA occurred and was stopped after the withdrawal of the catheter. Several hours after the operation, the patient developed occipital headache, back neck pain, dysarthria, and worsening left-sided hemiplegia. Magnetic resonance imaging revealed hyperintensity and swelling in the medulla oblongata and cervical cord, in addition to small medullary infarction. A digital subtraction angiography revealed intact vertebrobasilar arteries and patency of the left vertebral artery, left posterior inferior cerebellar artery, and implanted stent. We considered that the reperfusion injury had caused the complication. After treatment, the patient’s symptoms and neurologic deficits greatly improved. He achieved a favorable outcome at the 1-year follow-up, with normal intensity restored in the medulla oblongata and cervical cord on magnetic resonance imaging.ConclusionConcomitant reperfusion injury in the medulla oblongata and cervical cord secondary to vertebral artery angioplasty and stenting is extremely rare. However, this potentially devastating complication requires early recognition and prompt treatment. Maintaining the antegrade flow during vertebral artery endovascular treatment is a precaution against reperfusion injury.

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“…To date, decompressive surgery remains the most effective long-term treatment for this pathology, although the decision of which type of approach use and when to perform such a procedure remains challenging [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

The role of neuronal plasticity in cervical spondylotic myelopathy surgery: functional assessment and prognostic implication

Bonosi,

Musso,

Cusimano

et al. 2023

Neurosurg Rev

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Cervical spondylotic myelopathy (CSM) is a degenerative disease representing the most common spinal cord disorder in the adult population. It is characterized by chronic compression leading to neurological dysfunction due to static and dynamic injury of the spinal cord in cervical spine. These insidious damage mechanisms can result in the reorganization of cortical and subcortical areas. The cerebral cortex can reorganize due to spinal cord injury and may play a role in preserving neurological function. To date, the gold standard treatment of cervical myelopathy is surgery, comprising anterior, posterior, and combined approaches. However, the complex physiologic recovery processes involving cortical and subcortical neural reorganization following surgery are still inadequately understood. It has been demonstrated that diffusion MRI and functional imaging and techniques, such as transcranial magnetic stimulation (TMS) or functional magnetic resonance imaging (fMRI), can provide new insights into the diagnosis and prognosis of CSM. This review aims to shed light on the state-of-the-art regarding the pattern of cortical and subcortical areas reorganization and recovery before and after surgery in CSM patients, underlighting the critical role of neuroplasticity.

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White Cord Syndrome After Cervical or Thoracic Spinal Cord Decompression. Hemodynamic Complication or Mechanical Damage? An Underestimated Nosographic Entity

Cited by 7 publications

References 51 publications

Successful treatment of thoracic myelopathy caused by spontaneous spinal epidural hematoma (SSEH) combined with calcification of the ligamentum flavum (CLF) by posterior percutaneous endoscopic surgery (PPES): A case report

Successful treatment of thoracic myelopathy caused by spontaneous spinal epidural hematoma (SSEH) combined with calcification of the ligamentum flavum (CLF) by posterior percutaneous endoscopic surgery (PPES): A case report

Case report: Medulla oblongata and cervical cord reperfusion injury after intracranial vertebral artery angioplasty and stenting

The role of neuronal plasticity in cervical spondylotic myelopathy surgery: functional assessment and prognostic implication

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