Delayed Lower Extremity Monoplegia After Anterior Cervical Discectomy and Fusion: A Report of a Rare Case of Cervical Spinal Ischemic Reperfusion Injury.

White cord syndrome is an extremely rare type of cervical spinal cord ischemia characterized by sudden neurological deterioration following surgical spinal decompression. The underlying cause is believed to be immediate relief from chronic compression on the spinal cord, triggering an inflammatory response known as ischemic reperfusion injury. A 49-year-old male presented in the office with neck pain and chronic symptoms of progressive cervical myelopathy: clumsiness, gait instability, and dropping things. An MRI of the cervical spine demonstrated severe central canal stenosis with spinal cord compression and myelomalacia at the C3-C4 level. The patient underwent a planned anterior cervical discectomy and fusion procedure from C3 to C5. Following the surgery, he developed monoplegia in his left lower extremity. His postoperative MRI revealed white cord syndrome, characterized by an increase in the signal change of the spinal cord. This finding was consistent with an ischemic reperfusion injury to the spinal cord post-decompression. White cord syndrome is thought to be caused by a reperfusion injury following surgical decompression of a previously compressed segment of the spinal cord, characterized by the rapid return of blood flow. This involves oxidative damage caused by free oxygen radicals and inflammatory molecules, such as reactive oxygen species, which lead to lipid peroxidation of neuronal membranes. Surgeons should be aware of this rare complication and warn patients preoperatively.