Reperfusion "White Cord'' Syndrome in Cervical Spondylotic Myelopathy: Does Mean Arterial Pressure Goal Make a Difference? Additional Case and Literature Review.
Aged
Arterial Pressure
Cervical Vertebrae
/ surgery
Decompression, Surgical
Dexamethasone
/ therapeutic use
Glucocorticoids
/ therapeutic use
Humans
Magnetic Resonance Imaging
Male
Neurosurgical Procedures
Physical Therapy Modalities
Postoperative Complications
/ diagnostic imaging
Reperfusion Injury
/ diagnostic imaging
Spinal Cord Compression
/ diagnostic imaging
Spinal Cord Ischemia
/ etiology
Spinal Fusion
Spinal Stenosis
/ complications
Spondylosis
/ complications
MAP
Paraplegia
Posterior cervical decompression
Reperfusion injury
White cord syndrome
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
06
11
2019
revised:
07
01
2020
accepted:
08
01
2020
pubmed:
20
1
2020
medline:
22
7
2020
entrez:
20
1
2020
Statut:
ppublish
Résumé
"White cord syndrome" or reperfusion injury of chronically ischemic areas of the spinal cord is a relatively newly defined etiology in spinal surgery. This rare syndrome is characterized as unexplained new neurological deficits after an anterior or posterior decompressive cervical procedure. The radiographic hallmark is the presence of hyperintense T2 intramedullary signal change after a decompressive procedure without other pathologic changes. We present an additional case of this complication and review the literature. A 79-year-old man presented in consultation for advanced cervical myelopathy. He had experienced 2-3 months of worsening gait instability and issues with hand dexterity. Three days prior to presentation his lower extremity weakness had worsened to the point he was no longer able to ambulate. Magnetic resonance imaging (MRI) of the cervical spine demonstrated severe central canal stenosis secondary to spondylosis with T2 hyperintensity correlating to myelomalacia. He underwent an uncomplicated posterior cervical decompression and fusion and awoke with worsened right hemiparesis from neurologic baseline. Brain MRI was negative for stroke and MRI of the cervical spine showed successful decompression but worsening T2 signal changes. The patient's weakness improved with maintaining mean arterial pressure (MAP) goal, steroids, and physical therapy. He was eventually discharged to an acute rehabilitation facility. White cord syndrome is rare and has only been reported in 5 other patients upon review of the literature. Our case is the 7th general and the 5th after posterior cervical decompression. The pathophysiology is thought to be due to a reperfusion type injury of chronically ischemic areas of the spinal cord. All but one patient to date have improved after MAP goal, steroid administration therapy, and acute rehabilitation, including our patients. Spine surgeons should be aware of this potentially devastating complication and how to properly manage these patients' postoperative care.
Sections du résumé
BACKGROUND
"White cord syndrome" or reperfusion injury of chronically ischemic areas of the spinal cord is a relatively newly defined etiology in spinal surgery. This rare syndrome is characterized as unexplained new neurological deficits after an anterior or posterior decompressive cervical procedure. The radiographic hallmark is the presence of hyperintense T2 intramedullary signal change after a decompressive procedure without other pathologic changes. We present an additional case of this complication and review the literature.
CASE PRESENTATION
A 79-year-old man presented in consultation for advanced cervical myelopathy. He had experienced 2-3 months of worsening gait instability and issues with hand dexterity. Three days prior to presentation his lower extremity weakness had worsened to the point he was no longer able to ambulate. Magnetic resonance imaging (MRI) of the cervical spine demonstrated severe central canal stenosis secondary to spondylosis with T2 hyperintensity correlating to myelomalacia. He underwent an uncomplicated posterior cervical decompression and fusion and awoke with worsened right hemiparesis from neurologic baseline. Brain MRI was negative for stroke and MRI of the cervical spine showed successful decompression but worsening T2 signal changes. The patient's weakness improved with maintaining mean arterial pressure (MAP) goal, steroids, and physical therapy. He was eventually discharged to an acute rehabilitation facility.
CONCLUSIONS
White cord syndrome is rare and has only been reported in 5 other patients upon review of the literature. Our case is the 7th general and the 5th after posterior cervical decompression. The pathophysiology is thought to be due to a reperfusion type injury of chronically ischemic areas of the spinal cord. All but one patient to date have improved after MAP goal, steroid administration therapy, and acute rehabilitation, including our patients. Spine surgeons should be aware of this potentially devastating complication and how to properly manage these patients' postoperative care.
Identifiants
pubmed: 31954909
pii: S1878-8750(20)30070-X
doi: 10.1016/j.wneu.2020.01.062
pii:
doi:
Substances chimiques
Glucocorticoids
0
Dexamethasone
7S5I7G3JQL
Types de publication
Case Reports
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
194-199Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.