Papaioannou Ioannis, Repantis Thomas, Baikousis Andreas, Korovessis Panagiotis
Orthopedic Department of General Hospital of Patras Spine and Trauma Unit, Patras, Greece.
Spinal Cord Ser Cases. 2019 Mar 11;5:28. doi: 10.1038/s41394-019-0174-z. eCollection 2019.
In 2013, a rare early complication following cervical decompression the so-called "white cord syndrome" (WCS) was described for first time. This designation was given on the basis of the postoperative appearance of intramedullary hypertense areas in T2-MRI, resulting in devastating neurological damage. To our knowledge, only three cases of WCS have been published; we hereby present the fourth case, but the first one with late-onset presentation of this syndrome.
A 79-year-old male patient with Nurick grade 3 CSM was referred to our institution. He had already had a double-level C4-C6 anterior cervical decompression and fusion (ACDF) 2 years ago in another institution. The patient underwent posterior decompression from C3 to C6 plus C2-C7 lateral mass screw fusion. Within the first 24 h following surgery, he gradually developed C6 incomplete paraplegia (ASIA B). Cervical MRI disclosed a hypertensive signal in T2-weighted sequences at C6-C7 levels and the diagnosis of WCS was suspected. Revision surgery was made 30 h following our first surgery, with wider posterior decompression accompanied by intravenous methylprednisolone. The patient's neurologic status was improved, but the final neurologic outcome was worse (Nurick 4) than the preoperative status and subsequently did not change at all.
To the best of our knowledge, this is the first report of a late-onset WCS and the fourth case of WCS per se. Spine surgeons should be aware of this rare but serious complication. We highlight possible risk factors and review the literature on the hypotheses about the pathophysiology of WCS.
2013年，首次描述了颈椎减压术后一种罕见的早期并发症，即所谓的“白脊髓综合征”（WCS）。这一命名是基于T2加权磁共振成像（MRI）上脊髓内高张力区域的术后表现，其会导致严重的神经损伤。据我们所知，仅发表了3例WCS病例；我们在此报告第4例，但这是首例该综合征迟发性表现的病例。
一名79岁、Nurick 3级颈椎病脊髓型颈椎病（CSM）男性患者被转诊至我院。他两年前在另一家机构已接受过C4 - C6双节段颈椎前路减压融合术（ACDF）。该患者接受了C3至C6后路减压及C2 - C7侧块螺钉融合术。术后最初24小时内，他逐渐发展为C6不完全性截瘫（美国脊髓损伤协会[ASIA] B级）。颈椎MRI显示C6 - C7水平T2加权序列有高信号，怀疑为WCS。在我们首次手术后30小时进行了翻修手术，进行了更广泛的后路减压并静脉注射甲泼尼龙。患者的神经状态有所改善，但最终神经功能结果比术前更差（Nurick 4级），且随后完全没有变化。
据我们所知，这是首例迟发性WCS报告及WCS本身的第4例病例报告。脊柱外科医生应意识到这种罕见但严重的并发症。我们强调了可能的危险因素，并回顾了关于WCS病理生理学假说的文献。
