Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013:2013:697918.
doi: 10.1155/2013/697918. Epub 2013 Mar 4.

"White cord syndrome" of acute tetraplegia after anterior cervical decompression and fusion for chronic spinal cord compression: a case report

Kingsley R Chin  1 , Jason Seale, Vanessa Cumming
Affiliations

"White cord syndrome" of acute tetraplegia after anterior cervical decompression and fusion for chronic spinal cord compression: a case report

Kingsley R Chin et al. Case Rep Orthop. 2013.

Abstract

Paralysis is the most feared postoperative complication of ACDF and occurs most often due to an epidural hematoma. In the absence of a clear etiology, inadequate decompression or vascular insult such as ischemia/reperfusion injury are the usual suspects. Herewith we report a case of complete loss of somatosensory evoked potentials (SSEPs) during elective ACDF at C4-5 and C5-6 followed by postoperative C6 incomplete tetraplegia without any discernible technical cause. A postoperative MRI demonstrated a large area of high signal changes on T2-weighted MRI intrinsic to the cord "white cord syndrome" but no residual compression. This was considered consistent with spinal cord gliosis with possible acute edema. The acute decompression of the herniated disc resulted in cord expansion and rush-in reperfusion. We postulate that this may have led to disruption in the blood brain barrier (BBB) and triggered a cascade of reperfusion injuries resulting in acute neurologic dysfunction. At 16 months postoperatively our patient is recovering slowly and is now a Nurick Grade 4.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Preoperative axial T2-weighted MRI showing severe C5-6 cord compression by a massive disc herniation.
Figure 2
Figure 2
Preoperative MRI sagittal showing large area of high signal intensity centered behind the massive C5-6 herniated disc.
Figure 3
Figure 3
Immediate postoperative MRI after primary C4-5, C5-6 ACDF demonstrates residual C5 compression.
Figure 4
Figure 4
Day 3 postoperative MRI demonstrates more clearly the spinal cord edema intrinsic to the cord—a “white cord syndrome.”
Figure 5
Figure 5
Sagittal CT reconstruction at the latest followup shows graft consolidation confirming fusion.
Figure 6
Figure 6
Sagittal T2-weighted MRI at the latest 16-month followup showing a persistent “white cord syndrome.”
See this image and copyright information in PMC

References

    1. Mummaneni PV, Kaiser MG, Matz PG, et al. Cervical surgical techniques for the treatment of cervical spondylotic myelopathy. Journal of Neurosurgery. 2009;11(2):130–141. - PubMed
    1. Groff MW, Sriharan S, Lee SM, Maiman DJ. Partial corpectomy for cervical spondylosis. Spine. 2003;28(1):14–19. - PubMed
    1. Yang HS, Chen DY, Lu XH, et al. Choice of surgical approach for ossification of the posterior longitudinal ligament in combination with cervical disc hernia. European Spine Journal. 2010;19(3):494–501. - PMC - PubMed
    1. Jacobs W, Willems PC, van Limbeek J, et al. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database of Systematic Reviews. 2011;1:p. CD004958. - PubMed
    1. Kuntz C, Cramer DE, Maher PC, Pettigrew DB. Major neurologic deficit immediately after adult spinal surgery: incidence and etiology over 10 years at a single training institution. Journal of Spinal Disorders and Techniques. 2009;22(8):565–570. - PubMed

LinkOut - more resources