“White Cord Syndrome” of Acute Hemiparesis After Posterior Cervical Decompression and Fusion for Chronic Cervical Stenosis

Antwi, Prince; Grant, Ryan A.; Kuzmik, Gregory A.; Abbed, Khalid M.

doi:10.1016/j.wneu.2018.02.026

Cited by 39 publications

(39 citation statements)

References 7 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: 57%

“…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: 90%

“…Differential diagnosis of WCS includes iatrogenic trauma resulting in cerebrospinal fluid leakage and pseudo meningocele, cerebrovascular insult, and inception of an undiagnosed demyelinating disease [7]. In our case, we had excluded all these possible diagnoses, because we didn't find any hematoma or cerebrospinal fluid leakage, while the brain computed tomography and MRI scan were normal.…”

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: 57%

Section: Discussionmentioning

confidence: 90%

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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“…The patient was partially improved. Antwi et al [7] reported the case of a 68-year-old man affected by C4-6 severe cervical stenosis, who underwent C3-7 posterior decompression surgery. This was the first white cord syndrome case caused by posterior cervical operation.…”

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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“…Following on from the aforementioned study, white cord syndrome after anterior or posterior cervical decompression has received increasing attention. Antwi et al ( 17 ) reported the case of ‘white cord syndrome’ in a 68-year-old male who had developed acute hemiparesis on the left side following C4-C7 posterior laminectomy decompression in 2018. Also in 2018, Vinodh et al ( 3 ) reported similar findings in a 51-year-old female who was diagnosed with a metastatic intraspinal tumor and presented with quadriplegia following posterior cervical laminectomy and fusion for tumor resection.…”

Section: Discussionmentioning

confidence: 99%

‘White cord syndrome’, a rare but disastrous complication of transient paralysis after posterior cervical decompression for severe cervical spondylotic myelopathy and spinal stenosis: A case report

2020

Exp Ther Med

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Transient paralysis following spinal decompression surgery is a rare but devastating postoperative complication. Spinal cord ischemia-reperfusion injury has been identified as one of the crucial pathogenic factors contributing to the sudden neurological deterioration associated with spinal decompression surgery. ‘White cord syndrome’ is a characteristic imaging manifestation of spinal cord ischemia-reperfusion injury, referring to high intramedullary signal changes in the sagittal T2-weighted MRI scan with unexplained neurological deficits following surgical decompression. The present study reported on the case of a 51-year old male patient who suffered from acute left limb hemiplegic paralysis following posterior cervical laminectomy decompression for severe cervical spondylotic myelopathy and spinal stenosis, which were caused by ossification of the posterior longitudinal ligament. The patient's neurological function gradually improved after the immediate administration of high-dose methylprednisolone therapy combined with mannitol and neurotrophic drugs. At the 2-month follow-up, the intensity of the spinal cord signal on MRI had almost returned to normal and the ‘white cord syndrome’ had disappeared. However, the patient complained of postoperative neck swelling pain caused by cerebrospinal fluid leakage; therefore, an additional cerebrospinal fluid leakage exploration and neoplasty were performed. At 2 weeks after the second surgery, the patient's neck swelling pain was relieved and the area of cerebrospinal fluid leakage was significantly reduced. Despite the low incidence rate, surgeons should be aware of this complication, particularly when treating chronic severe cervical spinal stenosis with anterior or posterior decompression. Once transient paralysis occurs, early diagnosis and interventions are essential to reverse the neurological deficit.

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“White Cord Syndrome” of Acute Hemiparesis After Posterior Cervical Decompression and Fusion for Chronic Cervical Stenosis

Cited by 39 publications

References 7 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

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

‘White cord syndrome’, a rare but disastrous complication of transient paralysis after posterior cervical decompression for severe cervical spondylotic myelopathy and spinal stenosis: A case report

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“White Cord Syndrome” of Acute Hemiparesis After Posterior Cervical Decompression and Fusion for Chronic Cervical Stenosis

Cited by 39 publications

References 7 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

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

&lsquo;White cord syndrome&rsquo;, a rare but disastrous complication of transient paralysis after posterior cervical decompression for severe cervical spondylotic myelopathy and spinal stenosis: A case report

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‘White cord syndrome’, a rare but disastrous complication of transient paralysis after posterior cervical decompression for severe cervical spondylotic myelopathy and spinal stenosis: A case report