Department of Orthopedic Surgery, Gil Medical Center, Gachon University College of Medicine, University of Gachon, 21, Namdong-daero 774, Namdong-gu, Incheon, Republic of Korea.
BMC Musculoskelet Disord. 2020 Mar 12;21(1):157. doi: 10.1186/s12891-020-3162-3.
Objective: White cord syndrome is extremely rare and search of the literature has revealed very few cases. Postoperative MR scan revealed hyperintense intrinsic cord signal changes within cord ischemia and edema. It is thought to be caused by reperfusion injury of the spinal cord. This is called white cord syndrome. This report is very rare case of 'White Cord Syndrome' with paraplegia after anterior cervical discectomy and fusion (ACDF).
A 49-year-old woman presented with neck pain lasting for several months and second and third finger radiating pain. Severe cervical herniated intervertebral disc findings could be identified at C6-7 level on C-spine MRI. ACDF C6-7 surgery was performed. Immediately after the operation, physical examination revealed paraplegia and emergency MRI was performed. On MR images, T2 high signal myelopathy suspected as reperfusion injury at C6-7 level, and emergency surgery was performed under diagnosis of white cord syndrome. After the emergency operation, the paraplegic problem was gradually resolved. Before discharge, motor power and sensory deficit of bilateral lower extremity were fully recovered.
Surgeons should explain the possibility of white cord syndrome before cervical decompression surgery and should perform a neurological examination immediately after surgery. We recommend that the importance of early recognition and prompt treatment of white cord syndrome.
目的：白色脊髓综合征极为罕见，文献检索仅发现少数病例。术后磁共振扫描显示脊髓缺血和水肿内脊髓信号变化呈高信号。它被认为是脊髓再灌注损伤引起的。这被称为白色脊髓综合征。本报告是一例非常罕见的“白色脊髓综合征”病例，在前路颈椎间盘切除融合术（ACDF）后出现截瘫。
一位 49 岁女性因颈部疼痛持续数月，第二和第三手指放射痛就诊。颈椎 MRI 显示 C6-7 水平存在严重颈椎间盘突出。进行了 C6-7 的 ACDF 手术。术后即刻，体格检查发现截瘫，紧急进行 MRI 检查。在 MR 图像上，T2 高信号脊髓病，疑似 C6-7 水平的再灌注损伤，诊断为白色脊髓综合征并进行紧急手术。紧急手术后，截瘫问题逐渐得到解决。出院前，双侧下肢的运动和感觉缺陷完全恢复。
颈椎减压术前，外科医生应向患者解释发生白色脊髓综合征的可能性，并在术后立即进行神经学检查。我们建议早期识别和及时治疗白色脊髓综合征的重要性。
