White Cord Syndrome: A Reperfusion Injury Following Spinal Decompression Surgery

White cord syndrome (WCS) is a condition characterized by sudden motor weakness and the appearance of signal changes in the spinal cord on postoperative MRI after decompressive surgery. The most prominent theory attributes WCS to the sudden flow of blood due to reperfusion, causing damage to the spinal cord with ischemic damage after decompressive surgery. These procedures are known to be safe, and severe complications such as postoperative neurologic deterioration rarely occur unless there was a direct iatrogenic injury to the spinal cord itself.

• 1
  The patient developed quadriplegia immediately after anterior cervical discectomy and fusion (ACDF).
• 2
  Emergency MRI revealed a new and enlarged signal change in the spinal cord at the C4-7 level.
• 3
  After additional posterior decompression surgery and intense rehabilitation, the patient’s motor function improved to grade 4.