Session Title: AA 2022 Posters - Pain and Spine Medicine
Session Time: None. Available on demand.
Disclosures: Marina E. Kodsi, DO: No financial relationships or conflicts of interest
Case Diagnosis: 73-year-old male with suspected White Cord Syndrome (WCS) post anterior cervical discectomy and fusion (ACDF).
Case Description or Program Description: We present a patient who had an ACDF and developed new left sided paralysis upon awakening from anesthesia. His exam prior to surgery was normal expect for weakened bilateral grip, interossei strength, and left quadricep with positive Hoffman’s bilaterally. Postoperative exam revealed unchanged right-side findings but new significant left upper extremity weakness and loss of bowel and bladder sensation. Postoperative x-rays and evaluation of the patient’s surgical hardware showed no obvious abnormality. MRI imaging showed T2 hyperintensity at the C3-C4 level, and his spinal cord injury classification was C2 ASIA D.
Setting: Acute Inpatient Rehabilitation Center
Assessment/Results: Patient received a course of steroids postoperatively. He was admitted to inpatient rehab, but there was overall minimal functional recovery gained during the prolonged stay.
Discussion (relevance): This was a case of presumed WCS, which is a rare adverse event of cervical decompression surgery (specifically using anterior approach) leading to devastating outcomes for quality of life. After literature review, few cases were found, the first mentioned in 2013. It is postulated that WCS is caused by chronic ischemia from mechanical compression causing excessive oxidation stress and an increase in cytosolic acidosis which favors production of reactive oxygen species when reperfusion occurs. This leads to neuronal damage and loss of functionality. Given its rarity, there are no definitive risks or standard management that have been identified. Thus, providers must be knowledgeable of this syndrome and inform their patients of this possible adverse event to allow patients to make informed decisions for surgery.
Conclusions: WCS is a rare complication of ACDF, and requires further research to provide better understanding of the mechanism and management, leading to improved outcomes.
Level of Evidence: Level V
To cite this abstract in AMA style:Kodsi ME, Cleveland CA, Poirier M, Collette J. White Cord Syndrome as a Rare Complication of Cervical Decompression Surgery: A Case Report [abstract]. PM R. 2022; 14(S1)(suppl 1). https://pmrjabstracts.org/abstract/white-cord-syndrome-as-a-rare-complication-of-cervical-decompression-surgery-a-case-report/. Accessed December 3, 2023.
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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/white-cord-syndrome-as-a-rare-complication-of-cervical-decompression-surgery-a-case-report/