Misdiagnosis of “White Cord Syndrome” following posterior cervical surgery for ossification of the posterior longitudinal ligament: A case report

Abstract

Background: Following decompressive cervical surgery for significant spinal cord compression/myelopathy, patients may rarely develop the “White Cord Syndrome (WCS).” This acute postoperative reperfusion injury is characterized on T2W MRI images by an increased intramedullary cord signal. However, it is a diagnosis of exclusion, and WCS can only be invoked once all other etiologies for cord injury have been ruled out. Case Description: A 49-year-old male, 3 days following a C3-C7 cervical laminectomy and C2-T1 fusion for extensive cord compression due to ossification of the posterior longitudinal ligament (OPLL), developed acute quadriparesis. This new deficit should have been attributed to an intraoperative iatrogenic cord injury, not the WCS. Conclusion: Very rarely patients sustain postoperative significant/severe new neurological deficits attributable to the WCS. Notably, the WCS is a diagnosis of exclusion, and all other etiologies (i.e. intraoperative iatrogenic surgeon-based mechanical cord injury, graft/instrumentation extrusion, failure to adequately remove/resect OPLL thus stretching cord over residual disease, other reasons for continued cord compression, including the need for secondary surgery, etc.) of cord injury must first be ruled out.

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

“…Subsequently, the phospholipid membranes of neurons are damaged by the generation of such free radicals. 7 From a radiological perspective, white cord syndrome is characterized by a new hyperintense lesion on T2WI in the previously compressed spinal cord. This hyperintensity is usually detected through an MRI scan following the decompressive surgery.…”

“…Subsequently, the phospholipid membranes of neurons are damaged by the generation of such free radicals. 7…”

White Cord Syndrome After Cervical Laminoplasty in an 81-Year-Old Man

“…[5,6,[8][9][10]12] A newly developed neurological deficit that may be attributed to an intraoperative iatrogenic cord injury is not WCS. Acharya et al reported a case of quadriplegia following cervical posterior decompression surgery that had been caused by an intraoperative iatrogenic spinal cord injury, and WCS was misdiagnosed [17]. WCS is defined as an obvious postoperative motor neuropathy with an unexpected cause.…”