White cord syndrome—an unforeseen complication and diagnosis of exclusion: a case report and review of management

Background White cord syndrome is an unexpected and dreaded complication of decompression surgery in cervical myelopathy with an unforeseeable prognosis. Ischemic reperfusion injury has been advocated as an underlying pathophysiology. Not only must the surgeon be acquainted with this complication, but the patient should also be counseled before surgery regarding the expected outcome and worsening of neurological status after surgery in severe chronic compressive myelopathy. Case presentation A 48-year-old female presented with difficulty walking and numbness in all four limbs. The clinical and radiological assessment was suggestive of multilevel cervical cord compression. Posterior cervical decompression with C3–C7 lateral mass screw was performed. The patient developed a worsening neurological status in the immediate postoperative period. The patient was shifted to the intensive care unit and managed with high-dose dexamethasone along with monitoring and maintaining mean arterial pressure above 85 mm Hg. A partial improvement in neurology was noted during the in-hospital stay. The patient was attached to the local rehabilitation clinic. At the one-year follow-up, the patient was ambulatory with some residual numbness and weakness in the upper limbs. Conclusions White cord syndrome following spinal decompression in chronic cervical myelopathy is a rare, unfortunate complication and a diagnosis of exclusion with variable outcomes. An increase in signal hyper-intensity on T2-weighted MRI imaging in this entity is the most consistent finding. This report reviewed our current knowledge on the management of white cord syndrome based on our present experience.