White Cord Syndrome Following Cervical Surgery in a Patient With Klippel-Feil Syndrome: A Case Report

Cureus, 2024 · DOI: 10.7759/cureus.55353 · Published: March 1, 2024

Simple Explanation

White cord syndrome is a rare condition that can occur after cervical spine surgery, leading to neurological impairment. The syndrome is characterized by changes in the spinal cord, such as edema and ischemia, often seen on postoperative MRI scans. This case report describes a patient with Klippel-Feil syndrome who developed tetraplegia (paralysis of all four limbs) after undergoing cervical spine surgery, highlighting the importance of considering this potential complication.

Study Duration

Not specified

Participants

A 33-year-old male patient with Klippel-Feil syndrome

Evidence Level

Level 4, Case Report

Key Findings

1
The patient developed tetraplegia following a third surgical intervention involving occipitocervical fusion.
2
Postoperative MRI revealed spinal cord edema without hematoma, indicative of white cord syndrome.
3
Despite decompression and steroid treatment, the patient remained quadriplegic, emphasizing the challenges in managing this complication.

Research Summary

This case report describes a rare instance of white cord syndrome following cervical surgery in a patient with Klippel-Feil syndrome, resulting in tetraplegia. The patient underwent multiple surgeries due to cervical myelopathy and kyphotic malformation, eventually developing complete loss of intraoperative neurophysiologic control after occipitocervical fusion. Despite immediate intervention, including removal of fixation devices and steroid administration, the patient's neurological deficits persisted, underscoring the severity and management challenges of white cord syndrome.

Practical Implications

Preoperative Counseling

Surgeons should thoroughly explain the possibility of white cord syndrome to patients undergoing cervical decompression surgery.

Postoperative Monitoring

A detailed neurological examination is essential in every patient with severe cord compression after cervical surgery.

Early Recognition and Management

Early recognition and prompt management of white cord syndrome are highly recommended to optimize patient outcomes.

Study Limitations

1
Single case report limits generalizability.
2
Uncertainty regarding the exact pathophysiological mechanism of white cord syndrome.
3
Controversy surrounding optimal treatment protocols for postoperative white cord syndrome.

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