White cord syndrome after non-contiguous double-level anterior cervical decompression and fusion (ACDF): A “no reflow phenomenon”?

Giammalva, Giuseppe Roberto; Maugeri, Rosario; Graziano, Francesca; Gulì, Carlo; Giugno, Antonella; Basile, Luigi; Iacopino, Domenico Gerardo

doi:10.1016/j.inat.2016.12.001

Cited by 31 publications

(25 citation statements)

References 4 publications

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“…This designation was given because of the postoperative appearance of intramedullary hypertense areas in T2-weighted magnetic resonance imaging (MRI), resulting in devastating neurological damage. Since then, two new cases (one after anterior and one after posterior approach) of WCS with intraoperative onset of the neurological deficit have been recorded [6,7]. We report the fourth case of this rare syndrome, but in contrast to the previously reported three cases, manifestation of the neurologic deficit in our case appeared delayed and not intraoperatively.…”

Section: Introductioncontrasting

confidence: 58%

“…This designation was given due to postoperative appearance of intramedullary hypertense areas in T2-weighted magnetic Sagittal computed tomography image after the first decompression surgery to our department demonstrates the posterior decompression and fusion from C2 to C7, while no screw malposition was observed resonance (MR) images, resulting in devastating neurological damage [5]. This syndrome has already been described three times (two cases after anterior approach and one case after posterior decompression) in the literature (Table 1) [5][6][7]. In all previous cases the neurologic deficit occurred intraoperatively, whereas in our case the deficit first became manifest 24 h postoperatively.…”

Section: Discussionmentioning

confidence: 91%

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Late-onset “white cord syndrome” in an elderly patient after posterior cervical decompression and fusion: a case report

Papaioannou

Repantis

Baikousis

et al. 2019

Spinal Cord Ser Cases

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Introduction In 2013, a rare early complication following cervical decompression the so-called "white cord syndrome" (WCS) was described for first time. This designation was given on the basis of the postoperative appearance of intramedullary hypertense areas in T2-MRI, resulting in devastating neurological damage. To our knowledge, only three cases of WCS have been published; we hereby present the fourth case, but the first one with late-onset presentation of this syndrome. Case presentation A 79-year-old male patient with Nurick grade 3 CSM was referred to our institution. He had already had a double-level C4-C6 anterior cervical decompression and fusion (ACDF) 2 years ago in another institution. The patient underwent posterior decompression from C3 to C6 plus C2-C7 lateral mass screw fusion. Within the first 24 h following surgery, he gradually developed C6 incomplete paraplegia (ASIA B). Cervical MRI disclosed a hypertensive signal in T2weighted sequences at C6-C7 levels and the diagnosis of WCS was suspected. Revision surgery was made 30 h following our first surgery, with wider posterior decompression accompanied by intravenous methylprednisolone. The patient's neurologic status was improved, but the final neurologic outcome was worse (Nurick 4) than the preoperative status and subsequently did not change at all. Discussion To the best of our knowledge, this is the first report of a late-onset WCS and the fourth case of WCS per se. Spine surgeons should be aware of this rare but serious complication. We highlight possible risk factors and review the literature on the hypotheses about the pathophysiology of WCS.

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Section: Introductioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 91%

Late-onset “white cord syndrome” in an elderly patient after posterior cervical decompression and fusion: a case report

Papaioannou

Repantis

Baikousis

et al. 2019

Spinal Cord Ser Cases

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“…Sudden neurological deterioration following spinal decompression may be attributed to a reperfusion injury of the spinal cord. On the postoperative magnetic resonance (MR) scan, cord ischemia and edema are characterized by a hyperintense intrinsic cord signal, which is typically labeled as the “white cord syndrome.”[ 1 ]…”

Section: Introductionmentioning

confidence: 99%

White cord syndrome: A devastating complication of spinal decompression surgery

et al. 2018

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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.

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“…The patient was partially improved. And Giammalva et al [6] reported the case of a 64-year-old man affected by C4-6 severe cord compression, who underwent C3-4 and C5-6 ACDF. Tetraparesis occurred in the patient after surgery, and the patient was immediately started only high-dose steroid protocol (NASCIS III).…”

Section: Discussionmentioning

confidence: 99%

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

Jun

Baik

Lee

2020

BMC Musculoskelet Disord

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Background: Objective: White cord syndrome is extremely rare and search of the literature has revealed very few cases. Postoperative MR scan revealed hyperintense intrinsic cord signal changes within cord ischemia and edema. It is thought to be caused by reperfusion injury of the spinal cord. This is called white cord syndrome. This report is very rare case of 'White Cord Syndrome' with paraplegia after anterior cervical discectomy and fusion (ACDF). Case presentation: A 49-year-old woman presented with neck pain lasting for several months and second and third finger radiating pain. Severe cervical herniated intervertebral disc findings could be identified at C6-7 level on C-spine MRI. ACDF C6-7 surgery was performed. Immediately after the operation, physical examination revealed paraplegia and emergency MRI was performed. On MR images, T2 high signal myelopathy suspected as reperfusion injury at C6-7 level, and emergency surgery was performed under diagnosis of white cord syndrome. After the emergency operation, the paraplegic problem was gradually resolved. Before discharge, motor power and sensory deficit of bilateral lower extremity were fully recovered. Conclusion: Surgeons should explain the possibility of white cord syndrome before cervical decompression surgery and should perform a neurological examination immediately after surgery. We recommend that the importance of early recognition and prompt treatment of white cord syndrome.

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White cord syndrome after non-contiguous double-level anterior cervical decompression and fusion (ACDF): A “no reflow phenomenon”?

Cited by 31 publications

References 4 publications

Late-onset “white cord syndrome” in an elderly patient after posterior cervical decompression and fusion: a case report

Late-onset “white cord syndrome” in an elderly patient after posterior cervical decompression and fusion: a case report

White cord syndrome: A devastating complication of spinal decompression surgery

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

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