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Kim HW, Yong H, Shea GKH. Blood-spinal cord barrier disruption in degenerative cervical myelopathy. Fluids Barriers CNS 2023; 20:68. [PMID: 37743487 PMCID: PMC10519090 DOI: 10.1186/s12987-023-00463-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/12/2023] [Indexed: 09/26/2023] Open
Abstract
Degenerative cervical myelopathy (DCM) is the most prevalent cause of spinal cord dysfunction in the aging population. Significant neurological deficits may result from a delayed diagnosis as well as inadequate neurological recovery following surgical decompression. Here, we review the pathophysiology of DCM with an emphasis on how blood-spinal cord barrier (BSCB) disruption is a critical yet neglected pathological feature affecting prognosis. In patients suffering from DCM, compromise of the BSCB is evidenced by elevated cerebrospinal fluid (CSF) to serum protein ratios and abnormal contrast-enhancement upon magnetic resonance imaging (MRI). In animal model correlates, there is histological evidence of increased extravasation of tissue dyes and serum contents, and pathological changes to the neurovascular unit. BSCB dysfunction is the likely culprit for ischemia-reperfusion injury following surgical decompression, which can result in devastating neurological sequelae. As there are currently no therapeutic approaches specifically targeting BSCB reconstitution, we conclude the review by discussing potential interventions harnessed for this purpose.
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Affiliation(s)
- Hyun Woo Kim
- Department of Orthopaedics and Traumatology, LKS Faulty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Hu Yong
- Department of Orthopaedics and Traumatology, LKS Faulty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Graham Ka Hon Shea
- Department of Orthopaedics and Traumatology, LKS Faulty of Medicine, The University of Hong Kong, Hong Kong, China.
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Yen Hsin L, Samynathan C VV, Yilun H. White Cord Syndrome: A Treatment Dilemma. Cureus 2023; 15:e38177. [PMID: 37252488 PMCID: PMC10224717 DOI: 10.7759/cureus.38177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
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.
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Affiliation(s)
- Leong Yen Hsin
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore, SGP
| | | | - Huang Yilun
- Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore, SGP
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3
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Algahtani AY, Bamsallm M, Alghamdi KT, Alzahrani M, Ahmed J. Cervical Spinal Cord Ischemic Reperfusion Injury: A Comprehensive Narrative Review of the Literature and Case Presentation. Cureus 2022; 14:e28715. [PMID: 36204035 PMCID: PMC9527564 DOI: 10.7759/cureus.28715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2022] [Indexed: 11/22/2022] Open
Abstract
Cervical spinal ischemic reperfusion injury (CSIRI) refers to a state of sudden neurological deterioration after surgical spinal decompression. The CSCIRI refers to a state of sudden neurological deterioration after surgical spinal decompression. The pathophysiology is hypothesized to be due to instant relief of a chronically compressed spinal cord, leading to an inflammatory cascade named ischemic reperfusion injury. Deterioration of neurological function after cervical spine decompression surgery often occurs secondary to direct cord injury, compressing hematoma, or hardware failure. Complete loss of neurological function with no organic explanation is an extremely rare complication, with only a few cases reported in the literature. We are reporting a 67-year-old male patient diagnosed with severe cervical spinal canal stenosis at level C5/6 who underwent anterior cervical discectomy and fusion (ACDF). The patient developed complete transient loss of neurological functions after the surgery and was labeled as a case of CSCIRI after excluding compressing pathology. A literature review of the CSCIRI was carried out, and ten articles were included. Due to the rarity of these cases, there is no class 1 or 2 evidence to establish management protocol nor identifiable risk factors to predict their occurrence. However, we recommend using an intra-operative neurophysiology monitor in cases with long-standing severe cervical canal stenosis with myelomalacia and managing these cases according to the acute spinal cord injury management protocol after excluding compressing pathologies.
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"White cord syndrome after cervical or thoracic spinal cord decompression. Haemodynamic complication or mechanical damage? An understimated nosographic entity". World Neurosurg 2022; 164:243-250. [PMID: 35589039 DOI: 10.1016/j.wneu.2022.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/23/2022]
Abstract
The ischemia-reperfusion mechanism is believed to be responsible for parenchymal damage caused by temporary hypoperfusion and worsened by the subsequent attempt of reperfusion. This represents a true challenge for physicians of several fields, including neurosurgeons. A limited number of papers have shed the light on a rare pathological condition that affects patients experiencing an unexplained neurological deficit after spine surgery, the so-called "white cord syndrome". This entity is believed to be caused by an "ischemia-reperfusion" injury on the spinal cord, documented by a post-operative intramedullary hyperintensity on T2 weighted MRI sequences. To date, the cases of white cord syndrome reported in literature mostly refer to cervical spine surgery. However, the analysis of several reviews focusing on spine surgery outcome suggest that post-operative neurological deficits of new onset could be charged to a mechanism of ischemia-reperfusion, even if the physiopathology of this event is seldom explored or at least discussed. The same neuroradiological finding can suggest a mechanical damage due to surgical inappropriate manipulation. On this purpose, we performed a systematic revision of literature with the aim to identify and analyze all the factors potentially contributing to ischemic-reperfusion damage of the spinal cord that may potentially complicate any spinal surgery, without distinction between cervical or thoracic segment. Finally, we believe that post-operative neurological deficit after spinal surgery constituting the "white cord syndrome", could be underreported, while both neurosurgeons and patients should be fully aware of this rare but potentially devasting complication burdening cervical and thoracic spine surgery.
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5
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So JS, Kim YJ, Chung J. White Cord Syndrome: A Reperfusion Injury Following Spinal Decompression Surgery. Korean J Neurotrauma 2022; 18:380-386. [PMID: 36381466 PMCID: PMC9634306 DOI: 10.13004/kjnt.2022.18.e36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/25/2022] [Accepted: 05/13/2022] [Indexed: 12/24/2022] Open
Abstract
Reperfusion injury of the spinal cord has been scarcely reported. Herein, we present a case of white cord syndrome after spinal decompression. A 61-year-old male, who initially had ossification of the posterior longitudinal ligament at C3-6 level, was admitted to our hospital with a ruptured disc at the C6-7 level. The patient experienced radiating pain in both upper extremities. Anterior cervical discectomy and fusion was performed. However, the patient developed quadriplegia. Emergency magnetic resonance imaging revealed a new and enlarged signal change in the spinal cord at the C4-7 level. Additional posterior decompression surgery was performed. After intense rehabilitation, the patient’s motor function improved to grade 4. White cord syndrome is likely due to reperfusion injury following operative decompression of a compressed spinal cord segment. Although rare, spine surgeons should be aware of this complication and warn patients preoperatively.
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Affiliation(s)
- Jin-Shup So
- Department of Neurosurgery, Dankook University Hospital, Cheonan, Korea
| | - Young-Jin Kim
- Department of Neurosurgery, Dankook University Hospital, Cheonan, Korea
| | - Jaewoo Chung
- Department of Neurosurgery, Dankook University Hospital, Cheonan, Korea
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6
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Malinovic M, Walker J, Lee F. Ischemia-Reperfusion Injury After Posterior Cervical Laminectomy. Cureus 2021; 13:e18298. [PMID: 34722073 PMCID: PMC8547379 DOI: 10.7759/cureus.18298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 01/09/2023] Open
Abstract
Ischemia-reperfusion injury is a rare but serious complication encountered after spinal decompression surgery. This is only the 11th case reported in the literature. There is no current mainstay of treatment; however, several therapies have been studied. This case presents a patient with myelomalacia who underwent posterior laminectomy and developed diffuse cord edema with postoperative quadriplegia. Ischemia-reperfusion injury is believed to be mediated by oxidative and nitrosative stress leading to protein degradation and lipid peroxidation. It is characterized by myelomalacia in a chronically ischemic spinal cord and hyperintensity on T2-weighted MRI after decompression. Treatment has involved steroids and rehabilitation, and outcomes have ranged from minor improvement to full recovery. Novel treatment options have shown promise in animal models.
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Affiliation(s)
- Matea Malinovic
- Anesthesiology, University of Kansas School of Medicine, Wichita, USA
| | - James Walker
- Anesthesiology, University of Kansas School of Medicine, Wichita, USA
| | - Felecia Lee
- Anesthesiology, University of Kansas School of Medicine, Wichita, USA
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Segal DN, Lunati MP, Kukowski NR, Michael KW. White Cord Syndrome and Acute Tetraplegia After Posterior Cervical Decompression: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00120. [PMID: 34115641 DOI: 10.2106/jbjs.cc.20.00281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
CASE A 55-year-old man undergoes posterior cervical decompression and instrumentation for progressive cervical myelopathy and develops white cord syndrome (WCS) postoperatively with acute tetraplegia. CONCLUSION WCS is a rare complication of spinal surgery that is thought to be due to reperfusion injury. We diagnosed WCS in our patient through postoperative examination consisting of acute tetraplegia and magnetic resonance imaging revealing increased signal in the cord. In this case, we used intravenous dexamethasone and mean arterial pressure above 90 mm Hg resulting in markedly improved clinical examination.
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Affiliation(s)
- Dale N Segal
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Matthew P Lunati
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Nathan R Kukowski
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Keith W Michael
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia
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8
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Acharya S, Kaucha D, Sandhu AS, Adsul N, Chahal RS, Kalra KL. Misdiagnosis of "White Cord Syndrome" following posterior cervical surgery for ossification of the posterior longitudinal ligament: A case report. Surg Neurol Int 2021; 12:244. [PMID: 34221575 PMCID: PMC8247735 DOI: 10.25259/sni_268_2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/09/2021] [Indexed: 01/19/2023] Open
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.
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Affiliation(s)
- Shankar Acharya
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Deepak Kaucha
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Nitin Adsul
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - R S Chahal
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - K L Kalra
- Department of Ortho-Spine Surgery, Sir Ganga Ram Hospital, New Delhi, India
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9
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Singh RD, Arts MP, de Ruiter GCW. Delayed-onset white cord syndrome after anterior and posterior cervical decompression surgery for symptomatic ossification of spinal ligaments: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2021; 1:CASE2113. [PMID: 35854839 PMCID: PMC9245768 DOI: 10.3171/case2113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/10/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND White cord syndrome is an extremely rare complication of cervical decompressive surgery, characterized by serious postoperative neurological deficits in the absence of apparent surgical complications. It is named after the characteristic ischemic-edematous intramedullary T2-hyperintense signal on postoperative magnetic resonance imaging and is believed to be caused by ischemic-reperfusion injury. Neurological deficits typically manifest immediately after surgery, and delayed occurrence has been reported only once. OBSERVATIONS The authors presented two cases of delayed white cord syndrome after anterior and posterior cervical decompression surgery for symptomatic ossification of the posterior longitudinal ligament and ligamentum flavum, respectively. Neurological deficits manifested on postoperative day 2 (case 1) and day 8 (case 2). The patients’ conditions were managed with high-dose corticosteroids, mean arterial pressure augmentation, and early physical therapy, after which they showed partial neurological recovery at discharge, which improved further by the 3-month follow-up visit. LESSONS The authors’ aim was to raise awareness among spine surgeons about this rare but severe complication of cervical decompressive surgery and to emphasize the mainstays of treatment based on current best evidence: high-dose corticosteroids, mean arterial pressure augmentation, and early physical therapy.
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10
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Todd NV. Spinal reperfusion syndrome. A literature review and medicolegal implications. Br J Neurosurg 2021; 35:541-546. [PMID: 33754912 DOI: 10.1080/02688697.2021.1900539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Aim. To consider the diagnosis of spinal reperfusion syndrome (SRS) and its medicolegal implications.Materials and Methods. . A PRISMA guided PubMed search was performed to identify cases of possible SRS following spinal surgery.Result. Fourteen papers suggested that SRS might be the cause of neurological deterioration. In patients undergoing surgery for cervical degenerative disorders there were 7 patients who had new deficits immediately on awakening from the anaesthetic. There were 6 patients who had no new deficit immediately post-surgery with new deficits occurring within hours, or up to 3 days post-surgery.Conclusion. There is no agreed clinical definition of the SRS and the radiological abnormalities are not defined. The diagnosis of SRS can potentially be made by exclusion or inclusion. If there is a known cause of new neurological deficits intra- or immediately post-operatively, such as for example intraoperative cord injury, inadequate decompression or a haematoma, that is the probable diagnosis, not SRS. If a patient awakes with new deficits the most likely cause (if no other cause is identified) is intraoperative injury to the cord. If there is delayed deterioration with no cause identified SRS is a possible explanation. New deficits occur in 0.5 to 1.0% of patients undergoing anterior cervical spine surgery i.e. overall this is common whereas SRS is rare. The medicolegal implications are discussed.
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Affiliation(s)
- N V Todd
- Newcastle Nuffield Hospital, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
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11
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Kalidindi KKV, Sath S. "White Cord Syndrome" of Acute Tetraplegia after Posterior Cervical Decompression and Resulting Hypoxic Brain Injury. Asian J Neurosurg 2020; 15:756-758. [PMID: 33145248 PMCID: PMC7591215 DOI: 10.4103/ajns.ajns_240_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/14/2020] [Accepted: 07/12/2020] [Indexed: 11/25/2022] Open
Abstract
White cord syndrome (WCS) is a rare case of severe neurological deterioration after surgical decompression for cervical myelopathy. It was proposed to be secondary to an ischemia/reperfusion injury. An association of WCS with a hypoxic brain injury (HBI) has not been documented. A 63-year-old man presented to us with progressive symptoms of cervical myelopathy. Computed tomography scan and magnetic resonance imaging (MRI) scan findings were suggestive of an ossified posterior longitudinal ligament with cord atrophy and myelomalacia changes. He was managed surgically by decompression and fusion through a posterior approach. During the surgery, there was a sudden loss of neuromonitoring signals after laminectomy, and wake-up assessment revealed neurological deterioration. Immediate postoperative imaging revealed adequately placed screws and adequate cord decompression. A high dose of intravenous steroids was given. Repeat MRI scan on the 3rd postoperative day suggested cord edema over a large area on T2-weighted images. He was diagnosed as WCS and managed conservatively. He had persistent abdominal distension postoperatively, and a diagnostic endoscopy was advised. At the start of the procedure, the patient had a sudden-onset loss of consciousness. Electrocardiogram suggested bradyarrhythmias with hypotension. The patient was resuscitated, intubated, and shifted to intensive care unit. He was diagnosed to have a HBI. He was managed with multidisciplinary rehabilitation and discharged at 4 months' postoperatively with stable vitals. There was no improvement in the neurology or his consciousness. Spine surgeons have to be aware of this potentially disastrous complication of WCS. One should take adequate postoperative care to avoid preventable complications like HBI associated with it.
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12
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Sepulveda F, Carballo L, Carnevale M, Yañez P. White cord syndrome in a pediatric patient: A case report and review. Radiol Case Rep 2020; 15:2343-2347. [PMID: 32994838 PMCID: PMC7501484 DOI: 10.1016/j.radcr.2020.08.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 11/27/2022] Open
Abstract
White cord syndrome is a rare condition involving sudden neurological deterioration following a decompressive cervical spinal surgery and characterized by the appearance of hyperintensity on T2-weighted magnetic resonance imaging. We present a report of a pediatric male patient who presented with the condition. This case shows that white cord syndrome can also be present in pediatric patients. We provide a brief review of the literature highlighting the main radiologic findings.
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Affiliation(s)
- Francisco Sepulveda
- Department of Neuroradiology, Instituto de Neurocirugía Dr. Asenjo, José Manuel Infante 553, Santiago, Providencia, Santiago, Chile
| | | | | | - Paulina Yañez
- Department of Radiology, FLENI, Buenos Aires, Argentina
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13
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Liao YX, He SS, He ZM. '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. Exp Ther Med 2020; 20:90. [PMID: 32973939 PMCID: PMC7507019 DOI: 10.3892/etm.2020.9218] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 08/19/2020] [Indexed: 02/05/2023] Open
Abstract
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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Affiliation(s)
- Yu-Xin Liao
- Department of Orthopaedics, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, P.R. China
| | - Shi-Sheng He
- Department of Orthopaedics, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, P.R. China
| | - Zhi-Min He
- Department of Orthopaedics, Shanghai 10th People's Hospital, Tongji University School of Medicine, Shanghai 200072, P.R. China
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Giammattei L, Penet N, Padovan S, Florea M, Ducos Y, di Russo P, Froelich S. Decompensation of a Thoracic Meningioma Below the Operated Level: A Dramatic and Unexpected Complication. World Neurosurg 2020; 140:162-165. [PMID: 32389872 DOI: 10.1016/j.wneu.2020.04.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Paraplegia after lumbar spinal surgery has been previously described. It was generally provoked by a missed thoracic compression because of degenerative processes, arachnoid cyst, and spinal cord tumor such as meningioma. We describe here a case of a patient with neurofibromatosis type 2 (NF-2) with multiple spinal meningiomas that developed postoperative paraplegia because of decompensation of spinal cord compression below and far from the operated level. CASE DESCRIPTION A 54-year-old woman with NF-2 was followed-up for multiple spinal meningiomas (C7-T1, T6-7, T9-10 levels). Surgery for the symptomatic and larger lesion (C7-T1) was scheduled. Postoperatively, the patient was found to have paraplegia with sensor anesthesia below the level of the T6 vertebra. An urgent spinal magnetic resonance imaging (MRI) scan was performed revealing the absence of complication at the operated level (C7-T1) but the appearance of a marked intramedullary hyperintensity at the T6-7 level. An urgent T6-7 laminectomy and removal of the meningioma was performed. The postoperative phase was marked by a poor recuperation. Spinal MRI scan at 3 months clearly showed a severely injured spinal cord at the T6-7 level consistent with the neurologic status of the patient. CONCLUSIONS We report here the first case of acute neurologic deterioration after decompensation of a spinal cord compression below the operated level in spinal intradural surgery. Neurosurgeons must be aware of this possible complication when treating patients with multiple spinal meningiomas.
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Affiliation(s)
- Lorenzo Giammattei
- Neurosurgical Department, Lariboisière Hospital, Paris, France; Université Paris Diderot, Paris, France.
| | - Nicolas Penet
- Neurosurgical Department, Lariboisière Hospital, Paris, France; Université Paris Diderot, Paris, France
| | | | - Mihaela Florea
- Neurosurgical Department, Lariboisière Hospital, Paris, France
| | - Yohan Ducos
- Neurosurgical Department, Lariboisière Hospital, Paris, France
| | - Paolo di Russo
- Neurosurgical Department, Lariboisière Hospital, Paris, France
| | - Sebastien Froelich
- Neurosurgical Department, Lariboisière Hospital, Paris, France; Université Paris Diderot, Paris, France
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15
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Reperfusion “White Cord’’ Syndrome in Cervical Spondylotic Myelopathy: Does Mean Arterial Pressure Goal Make a Difference? Additional Case and Literature Review. World Neurosurg 2020; 137:194-199. [DOI: 10.1016/j.wneu.2020.01.062] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/19/2022]
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