White Cord Syndrome: The Terrible Nightmare

Fathalla, Hussein; Ragab, Omar; Ashry, Ahmed Hamdy

doi:10.4236/ojmn.2020.102030

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…5 Prior literature have shown that the various causes for cord compression included focal disc herniation with canal stenosis, other acquired causes like arachnoid cyst and even mass lesions such as metastasis involving vertebra. 6 In our patient, primary pathology was an osteochondroma at cervicodorsal junction causing cord compression.…”

Section: Discussionmentioning

confidence: 66%

Reperfusion Injury in the Cord—Rare Case of Pediatric White Cord Syndrome

Sundaram

Balasubramanian

Christopher

et al. 2022

Journal of Stroke Medicine

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Background: Postoperative neurological deficits following spinal decompression are often caused due to an expanding hematoma or other iatrogenic injuries. When a definitive etiology could not be identified, it may rarely be related to a reperfusion injury. Such unexplained neurological deficits are often associated with the presence of cord signal changes on imaging. It is assumed to result from ischemia-reperfusion injury and is often designated as “white cord syndrome” due to its imaging appearance. Such a diagnosis is made after excluding other differentials. Outcomes are variable based on the current literature. We report a patient with possible white cord syndrome following decompression and excision of cervicodorsal osteochondroma. Case Description: In this case report, we present a young patient who was admitted with slowly progressive paraplegia, and initial imaging showed C7-D1 pedunculated osteochondroma. He underwent an uneventful spinal laminectomy accompanied by tumor excision. In the immediate postoperative period, the patient became paraplegic and a follow-up magnetic resonance imaging was taken. It showed re-expansion of cord in the region of compression by the mass lesion at C7-D1 level with interval abnormal T2/IR hyper intensity extending from C6 to D1 levels. Conclusion: White cord syndrome is an extremely rare condition. It is postulated to be caused by reperfusion injury to the cord within areas of chronic ischemia due to compressive causes. We describe a child with white cord syndrome following decompression and excision of an osteochondroma.

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Section: Discussionmentioning

confidence: 66%

Reperfusion Injury in the Cord—Rare Case of Pediatric White Cord Syndrome

Sundaram

Balasubramanian

Christopher

et al. 2022

Journal of Stroke Medicine

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Cervical Spinal Cord Ischemic Reperfusion Injury: A Comprehensive Narrative Review of the Literature and Case Presentation

Algahtani¹,

Bamsallm²,

Alghamdi³

et al. 2022

Cureus

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Cervical spinal ischemic reperfusion injury (CSIRI) refers to a state of sudden neurological deterioration after surgical spinal decompression. The CSCIRI refers to a state of sudden neurological deterioration after surgical spinal decompression. The pathophysiology is hypothesized to be due to instant relief of a chronically compressed spinal cord, leading to an inflammatory cascade named ischemic reperfusion injury. Deterioration of neurological function after cervical spine decompression surgery often occurs secondary to direct cord injury, compressing hematoma, or hardware failure. Complete loss of neurological function with no organic explanation is an extremely rare complication, with only a few cases reported in the literature. We are reporting a 67-year-old male patient diagnosed with severe cervical spinal canal stenosis at level C5/6 who underwent anterior cervical discectomy and fusion (ACDF). The patient developed complete transient loss of neurological functions after the surgery and was labeled as a case of CSCIRI after excluding compressing pathology. A literature review of the CSCIRI was carried out, and ten articles were included. Due to the rarity of these cases, there is no class 1 or 2 evidence to establish management protocol nor identifiable risk factors to predict their occurrence. However, we recommend using an intra-operative neurophysiology monitor in cases with long-standing severe cervical canal stenosis with myelomalacia and managing these cases according to the acute spinal cord injury management protocol after excluding compressing pathologies.

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Delayed Lower Extremity Monoplegia After Anterior Cervical Discectomy and Fusion: A Report of a Rare Case of Cervical Spinal Ischemic Reperfusion Injury

Zach,

Abdulhamid,

Valizadeh

et al. 2024

Cureus

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White cord syndrome is an extremely rare type of cervical spinal cord ischemia characterized by sudden neurological deterioration following surgical spinal decompression. The underlying cause is believed to be immediate relief from chronic compression on the spinal cord, triggering an inflammatory response known as ischemic reperfusion injury. A 49-year-old male presented in the office with neck pain and chronic symptoms of progressive cervical myelopathy: clumsiness, gait instability, and dropping things. An MRI of the cervical spine demonstrated severe central canal stenosis with spinal cord compression and myelomalacia at the C3-C4 level. The patient underwent a planned anterior cervical discectomy and fusion procedure from C3 to C5. Following the surgery, he developed monoplegia in his left lower extremity. His postoperative MRI revealed white cord syndrome, characterized by an increase in the signal change of the spinal cord. This finding was consistent with an ischemic reperfusion injury to the spinal cord post-decompression. White cord syndrome is thought to be caused by a reperfusion injury following surgical decompression of a previously compressed segment of the spinal cord, characterized by the rapid return of blood flow. This involves oxidative damage caused by free oxygen radicals and inflammatory molecules, such as reactive oxygen species, which lead to lipid peroxidation of neuronal membranes. Surgeons should be aware of this rare complication and warn patients preoperatively.

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White Cord Syndrome: The Terrible Nightmare

Cited by 3 publications

References 15 publications

Reperfusion Injury in the Cord—Rare Case of Pediatric White Cord Syndrome

Reperfusion Injury in the Cord—Rare Case of Pediatric White Cord Syndrome

Cervical Spinal Cord Ischemic Reperfusion Injury: A Comprehensive Narrative Review of the Literature and Case Presentation

Delayed Lower Extremity Monoplegia After Anterior Cervical Discectomy and Fusion: A Report of a Rare Case of Cervical Spinal Ischemic Reperfusion Injury

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