{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T19:54:03Z","timestamp":1767988443392,"version":"3.49.0"},"reference-count":8,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground: <\/jats:title>\nFollowing acute cervical spinal cord decompression, a subset of patients may develop acute postoperative paralysis due to Reperfusion Injury (RPI)\/White Cord Syndrome (WCS). Pathophysiologically, this occurs due to the immediate restoration of normal blood flow to previously markedly compressed, and under-perfused\/ischemic cord tissues. On emergent postoperative MR scans, the classical findings for RPI\/ WCS include new or expanded, and focal or diffuse intramedullary hyperintense cord signals consistent with edema\/ischemia, swelling, and\/or intrinsic hematoma. To confirm RPI\/WCS, MR studies must exclude extrinsic cord pathology (e.g. extramedullary hematomas, new\/residual compressive disease, new graft\/vertebral fracture etc.) that may warrant additional cervical surgery to avoid permanent neurological sequelae.<\/jats:p>\n<\/jats:sec>\n\nMethods: <\/jats:title>\nIn the English literature (i.e. excluding 2 Japanese studies), 9 patients were identified with postoperative RPI\/WCS following cervical surgical procedures. For 7 patients, new acute postoperative neurological deficits were appropriately attributed to MR-documented RPI\/WCS syndromes (i.e. hyperintense cord signals). However, for 2 patients who neurologically worsened, MR studies demonstrated residual extrinsic disease (e.g. stenosis and OPLL) warranting additional surgery; therefore, these 2 patients did not meet the criteria for RPI\/WCS.<\/jats:p>\n<\/jats:sec>\n\nResults: <\/jats:title>\nThe diagnosis of RPI\/WCS is one of exclusion. It is critical to rule out residual extrinsic cord compression where secondary surgery may improve\/resolve neurological deficits.<\/jats:p>\n<\/jats:sec>\n\nConclusions: <\/jats:title>\nPatients with acute postoperative neurological deficits following cervical spine surgery must undergo MR studies to rule out extrinsic cord pathology before being diagnosed with RPI\/WCS. Notably, 2 of the 9 cases of RPI\/WCS reported in the literature required additional surgery to address stenosis and OPLL, and therefore, did not have the RPI\/WCS syndromes.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_555_2020","type":"journal-article","created":{"date-parts":[[2020,10,2]],"date-time":"2020-10-02T06:50:17Z","timestamp":1601621417000},"page":"320","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["Reperfusion Injury (RPI)\/White Cord Syndrome (WCS) Due to Cervical Spine Surgery: A Diagnosis of Exclusion"],"prefix":"10.25259","volume":"11","author":[{"given":"Nancy E.","family":"Epstein","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2020,10,2]]},"reference":[{"issue":"1","key":"10.25259\/SNI_555_2020\/ref-1","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1007\/s00586-014-3398-4","article-title":"Major neurological deficit following anterior cervical decompression and fusion: what is the next step?","volume":"24","author":"Bayley","year":"2015","journal-title":"Eur Spine J"},{"key":"10.25259\/SNI_555_2020\/ref-2","first-page":"697918","article-title":"White cord syndrome\u201d of acute tetraplegia after anterior cervical decompression and fusion for chronic spinal cord compression: a case report","volume":"2013","author":"Chin","year":"2013","journal-title":"Case Rep Orthop"},{"key":"10.25259\/SNI_555_2020\/ref-3","first-page":"47","article-title":"White cord syndrome after non-contiguous double-level anterior cervical decompression and fusion (ACDF): A \u201cno reflow phenomenon\u201d?","volume":"7","author":"Giammalva","year":"2017","journal-title":"Interdiscip Neurosurg Adv Tech Case Manag"},{"key":"10.25259\/SNI_555_2020\/ref-4","doi-asserted-by":"crossref","first-page":"bcr2017219863","DOI":"10.1136\/bcr-2017-219863","article-title":"Delayed spinal cord infarction following anterior cervical surgical decompression","volume":"Oct 9","author":"Khan","year":"2017","journal-title":"BMJ Case Reports"},{"issue":"13","key":"10.25259\/SNI_555_2020\/ref-5","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1097\/01.BRS.0000128757.32816.19","article-title":"Postoperative Expansion of Intramedullary High-Intensity Areas on T2-weighted Magnetic Resonance Imaging After Cervical Laminoplasty","volume":"29","author":"Seichi","year":"2004","journal-title":"Spine"},{"key":"10.25259\/SNI_555_2020\/ref-6","doi-asserted-by":"crossref","first-page":"136","DOI":"10.4103\/sni.sni_96_18","article-title":"White cord syndrome: A devastating complication of spinal decompression surgery","volume":"9","author":"Vinodh","year":"2018","journal-title":"Surgical Neurol Int"},{"issue":"7","key":"10.25259\/SNI_555_2020\/ref-7","first-page":"e5279","article-title":"Spinal Cord Reperfusion Injury: Case Report, Review of the Literature, and Future Treatment Strategies, Cureus","volume":"11","author":"Wiginton","year":"2019"},{"issue":"1","key":"10.25259\/SNI_555_2020\/ref-8","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1111\/os.12021","article-title":"Transient paralysis shortly after anterior cervical corpectomy and fusion","volume":"5","author":"Zhang","year":"2013","journal-title":"Orthop Surg"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/reperfusion-injury-rpi-white-cord-syndrome-wcs-due-to-cervical-spine-surgery-a-diagnosis-of-exclusion\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/reperfusion-injury-rpi-white-cord-syndrome-wcs-due-to-cervical-spine-surgery-a-diagnosis-of-exclusion\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,10,2]],"date-time":"2020-10-02T06:50:20Z","timestamp":1601621420000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/reperfusion-injury-rpi-white-cord-syndrome-wcs-due-to-cervical-spine-surgery-a-diagnosis-of-exclusion\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,2]]},"references-count":8,"alternative-id":["10.25259\/SNI_555_2020"],"URL":"https:\/\/doi.org\/10.25259\/sni_555_2020","relation":{},"ISSN":["2152-7806"],"issn-type":[{"value":"2152-7806","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,2]]},"article-number":"320"}}