Reperfusion injury case following cervical fusion with OPLL: a case report and literature review

Abstract

Introduction: Spinal cord ischemic reperfusion injury is characterized by an abrupt decline in neurological function and only a few cases have been published in literature. Herein, we present a white cord syndrome following anterior decompression cervical fusion.

Case report: A 54-year-old Jewish male patient was diagnosed with disc herniation among the intervertebral discs at C2, C3, C4, C6, and C7, along with ossification of the posterior longitudinal ligament, pressuring more to the right side of the spinal canal, ruling-out cervical myelopathy. Under general anesthesia and multimodal intraoperative monitoring, he underwent laminectomy surgery from C3 to C6 and cervical fixation from C3 to C7. No blood pressure fluctuations occurred during surgery, and complete pressure release was achieved on the spinal cord and the nerve roots. In addition, neuromonitoring did not indicate any nerve damage during the surgery. A neurologic exam in the post-anesthesia care unit revealed weakness in his right hand and leg. A brain computed tomography scan ruled out cerebrovascular accident, neck computed tomography revealed optimal implant position, and magnetic resonance imaging ruled out spinal cord distress or injury. We treated him with intravenous fluids, steroids, painkillers, and anticoagulants. Following surgery, we involved the occupational therapy department. After a few days, we observed a significant improvement in motor function in the right leg; however, there was no change in the right hand.

Conclusion: White cord syndrome likely arises from reperfusion injury subsequent to surgical decompression of a compressed spinal cord segment. Although infrequent, it is imperative for spine surgeons to recognize this potential complication and apprise patients of it prior to the procedure.

Keywords: Cervical decompression surgery; Laminectomy; Reperfusion injury; White cord syndrome.

Fig. 1

a Sagittal computed tomography demonstrating segmental ossification of the posterior longitudinal ligament up to C4. b Axial computed tomography demonstrating segmental ossification of the posterior longitudinal ligament. c Sagittal T2-weighted magnetic resonance imaging demonstrating the segmental ossification of the posterior longitudinal ligament at C2,C3, and C4

Fig. 2

a Sagittal T1-weighted magnetic resonance imaging demonstrating disc herniation among the intervertebral discs at C2, C3, C4, C6, and C7, along with ossification of the posterior longitudinal ligament. b Axial T1-weighted magnetic resonance imaging demonstrating pressure more to the right side of the spinal canal at the level of C3–C4

Fig. 3

The patient underwent laminectomy surgery from C3 to C6 and cervical fixation from C3 to C7. In both anterior–posterior and lateral X-rays the fixation shows optimal implant position

Fig. 4

Postoperative T2-weighted magnetic resonance image of the cervical spine in patient with severe cervical stenosis revealing punctuate myelopathy at C4. Postoperative magnetic resonance image showing complete decompression of cervical spinal cord and hyperintensity at C1