Busack Christopher D, Eagleton Bernard E
Department of Anesthesiology, Tulane University School of Medicine, New Orleans, LA.
Ochsner J. 2020 Fall;20(3):334-338. doi: 10.31486/toj.19.0081.
New neurologic deficits after spine surgery occur in less than 1% of cases. A particularly rare complication is white cord syndrome, a neurologic deterioration in the absence of obvious perioperative injury with concurrent hyperintense signal change on T2-weighted magnetic resonance imaging. The pathophysiologic mechanism is hypothesized to be an ischemia-reperfusion injury after the decompression of a chronically ischemic cord. A 63-year-old male underwent posterior cervical decompression and fusion for severe cervical stenosis and myelopathy. During the procedure, intraoperative neurophysiologic monitoring signals were lost. The patient developed acute postoperative tetraplegia attributed to white cord syndrome. Motor and sensory deficits improved after intravenous dexamethasone and intensive physical therapy. The pathophysiology of white cord syndrome is unclear, and intraoperative anesthetic management strategies to prevent this syndrome are unknown. This case serves to educate perioperative physicians to suspect this rare syndrome, encourage research into its pathophysiology, and guide clinicians in formulating therapeutic regimens.
脊柱手术后出现新的神经功能缺损的病例不到1%。一种特别罕见的并发症是白脊髓综合征，即在没有明显围手术期损伤的情况下出现神经功能恶化，同时在T2加权磁共振成像上有高强度信号改变。其病理生理机制被推测为慢性缺血脊髓减压后的缺血再灌注损伤。一名63岁男性因严重颈椎管狭窄和脊髓病接受了后路颈椎减压融合术。手术过程中，术中神经生理监测信号消失。患者因白脊髓综合征出现急性术后四肢瘫痪。静脉注射地塞米松和强化物理治疗后，运动和感觉功能缺损有所改善。白脊髓综合征的病理生理学尚不清楚，预防该综合征的术中麻醉管理策略也未知。该病例旨在教育围手术期医生怀疑这种罕见综合征，鼓励对其病理生理学进行研究，并指导临床医生制定治疗方案。
