White Cord Syndrome: A Treatment Dilemma

Cureus, 2023 · DOI: 10.7759/cureus.38177 · Published: April 26, 2023

Simple Explanation

White cord syndrome (WCS) is a rare complication following spinal decompressive surgery, characterized by neurological deterioration without perioperative injury. It is believed that the syndrome results from reperfusion injury where blood flow restoration to previously ischemic tissues causes damage to the spinal cord. Diagnosis involves identifying hyperintensity on T2-weighted MRI, and treatment includes high-dose steroids and addressing the underlying causes.

Study Duration

Not specified

Participants

A 61-year-old male

Evidence Level

Case Report

Key Findings

1
The patient developed bilateral C8 numbness six days post-operation, which progressively worsened to right hemisensory loss and right triceps atrophy.
2
Postoperative MRI revealed a new focal gliosis/edema within the spinal cord at C6/C7, indicating white cord syndrome.
3
Conservative treatment with pregabalin and rehabilitation was initiated, but the patient's condition highlights the challenges in managing WCS.

Research Summary

White cord syndrome (WCS) is a rare complication following spinal decompressive surgery, leading to neurological deterioration due to ischemic reperfusion injury. Diagnosis of WCS relies on MRI findings of hyperintensity and exclusion of other causes, with treatment primarily involving high-dose steroids and supportive measures. Preventive measures like remote ischemic preconditioning (RIPC) and intraoperative monitoring, along with timely decompression, may reduce the risk of WCS.

Practical Implications

Awareness and Counseling

Surgeons should be aware of WCS as a potential complication and counsel patients about the risks before spinal decompressive surgery.

Early Diagnosis and Intervention

Early diagnosis via MRI and prompt initiation of high-dose steroids and other supportive treatments are crucial for managing WCS effectively.

Preventive Strategies

Implementing preventive strategies such as RIPC and intraoperative monitoring can potentially reduce the incidence of WCS.

Study Limitations

1
The study is a single case report, limiting the generalizability of the findings.
2
The delayed presentation of WCS in this case may not be representative of all WCS cases.
3
The lack of a standardized treatment protocol for WCS makes it challenging to determine the most effective management approach.

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