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Abstract

Spinal cord reperfusion injury following decompressive surgery is extremely rare. This complication is known as white cord syndrome (WCS).

A 61-year-old male presented with chronic neck stiffness associated with left C6/C7 radiculopathy and numbness. Magnetic resonance imaging (MRI) of the cervical spine reported a severely narrowed left C6/C7 neural exit canal. C6/C7 anterior cervical decompression and fusion (ACDF) was performed. There was no significant intraoperative injury. On postoperative day 6, the patient developed bilateral C8 numbness, which started post-operation. He was treated for surgical site inflammation and was prescribed prednisolone and amitriptyline. However, his condition progressively worsened. At postoperative six weeks, there was right hemisensory loss, right triceps atrophy, and positive right Lhermitte’s and Hoffman’s tests. This subsequently progressed to right C7 weakness and bilateral lower limb radiculopathy at postoperative eight weeks. Postoperative MRI of the cervical spine revealed a new focal gliosis/edema within the spinal cord at C6/C7. The patient was treated conservatively with pregabalin and was referred for rehabilitation.

Early diagnosis and treatment initiation are crucial in the management of WCS. Surgeons should be aware of this potential complication and counsel patients on the risk prior to surgery. Magnetic resonance imaging (MRI) remains the gold standard in the diagnosis of WCS. The current mainstay of treatment is high-dose steroids, intraoperative neurophysiological monitoring, and early recognition of postoperative WCS.

Introduction

White cord syndrome (WCS) is an extremely rare complication. It is thought to be a result of reperfusion injury following spinal decompressive surgery, causing neurological deterioration in the absence of perioperative injury [1]. The presence of intramedullary hyperintense area in postoperative T2-weighted magnetic resonance imaging (MRI), without other pathological signs, is the hallmark of WCS [2].

Case Presentation

A 61-year-old male presented with chronic neck stiffness associated with left C6/C7 radiculopathy and numbness. The symptoms were aggravated in a sitting position and relieved on lying down. He had no limb weakness, fever, night pain, weight loss, or upper back pain. On examination, there was no spinal tenderness. However, the cervical extension was limited, and Spurling’s test was positive on the left side. Power, sensation, and reflexes were...(More)

For more info please read, White Cord Syndrome: A Treatment Dilemma, by Cureus