{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T15:27:01Z","timestamp":1767972421503,"version":"3.49.0"},"reference-count":13,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"\nBackground: <\/jats:title>\nWhite cord syndrome (WCS) refers to the observation of intramedullary hyperintensity due to edema\/ischemia and swelling on postoperative T2-weighted MRI sequences in the setting of unexplained neurological deficits after cervical spinal cord decompression. Pathophysiologically, WCS\/reperfusion injury (RPI) occurs due to oxygen derived free radicals as a result of acute reperfusion or direct trauma from blood flow itself. Intraoperative neurophysiologic monitoring (IONM) can give early warning and detect neurologic deficits. Here, we are presenting a case of a patient who had a chronic severe ossification of posterior longitudinal ligament (OPLL) of cervical cord, underwent decompressive surgery, and developed quadriplegia postoperatively without any perceptible iatrogenic cord trauma, documented by IONM and postoperative MRI with classical signs of WCS.<\/jats:p>\n<\/jats:sec>\n\nCase Description: <\/jats:title>\nA 63-year-old male presented with low velocity fall at home followed by quadriparesis. X-ray images on presentation showed C6 fracture and local kyphosis. MRI images showed that there is marked spinal canal stenosis from C2 down to C4 due to OPLL with intrinsic signal changes in the cord. On decompression, motor-evoked potential signals were not present below C4. Immediate postoperative MRI was done to rule out any compressive pathology. MRI showed T2 hyperintensity of the cord at C3 level with cord edema. No evidence of epidural hematoma or other compressive lesion was found and the diagnosis of WCS\/RPI was established.<\/jats:p>\n<\/jats:sec>\n\nConclusion: <\/jats:title>\nWCS is essentially a diagnosis of exclusion. Very rarely, patients sustain severe\/new neurological deficits postoperatively attributed to WCS. Unless, this is confirmed postoperatively with classical MRI signs of intramedullary hyperintensity, the diagnosis should not be invoked.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_692_2022","type":"journal-article","created":{"date-parts":[[2022,10,28]],"date-time":"2022-10-28T08:42:21Z","timestamp":1666946541000},"page":"501","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["White cord syndrome following posterior decompression and fusion for severe OPLL and an acute traumatic cervical injury \u2013 A case report and review of literature"],"prefix":"10.25259","volume":"13","author":[{"given":"Aditya Anand","family":"Dahapute","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sai Gautham","family":"Balasubramanian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Prokopis","family":"Annis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2022,10,28]]},"reference":[{"key":"10.25259\/SNI_692_2022\/ref-1","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/j.wneu.2018.02.026","article-title":"\u201cWhite cord syndrome\u201d of acute hemiparesis after posterior cervical decompression and fusion for chronic cervical stenosis","volume":"113","author":"Antwi","year":"2018","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_692_2022\/ref-2","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_692_2022\/ref-3","doi-asserted-by":"crossref","first-page":"334","DOI":"10.31486\/toj.19.0081","article-title":"White cord syndrome causing transient tetraplegia after posterior decompression and fusion","volume":"20","author":"Busack","year":"2020","journal-title":"Ochsner J"},{"key":"10.25259\/SNI_692_2022\/ref-4","first-page":"697918","article-title":"\u201cWhite 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_692_2022\/ref-5","doi-asserted-by":"crossref","first-page":"320","DOI":"10.25259\/SNI_555_2020","article-title":"Reperfusion injury (RPI)\/white cord syndrome (WCS) due to cervical spine surgery: A diagnosis of exclusion","volume":"11","author":"Epstein","year":"2020","journal-title":"Surg Neurol Int"},{"key":"10.25259\/SNI_692_2022\/ref-6","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.inat.2016.12.001","article-title":"White cord syndrome after non-contiguous double-level anterior cervical decompression and fusion (ACDF): A \u201cno reflow phenomenon?","volume":"7","author":"Giammalva","year":"2017","journal-title":"\u201d Interdiscip Neurosurg"},{"key":"10.25259\/SNI_692_2022\/ref-7","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1186\/s12891-020-3162-3","article-title":"A case report: White cord syndrome following anterior cervical discectomy and fusion: Importance of prompt diagnosis and treatment","volume":"21","author":"Jun","year":"2020","journal-title":"BMC Musculoskelet Dis"},{"key":"10.25259\/SNI_692_2022\/ref-8","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.nbd.2013.02.013","article-title":"A novel experimental model of cervical spondylotic myelopathy (CSM) to facilitate translational research","volume":"54","author":"Karadimas","year":"2013","journal-title":"Neurobiol Dis"},{"key":"10.25259\/SNI_692_2022\/ref-9","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.wneu.2020.01.062","article-title":"Reperfusion \u201cwhite cord\u2019\u2019 syndrome in cervical spondylotic myelopathy: Does mean arterial pressure goal make a difference? Additional case and literature review","volume":"137","author":"Mathkour","year":"2020","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_692_2022\/ref-10","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 (Phila Pa 1976)"},{"key":"10.25259\/SNI_692_2022\/ref-11","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":"Surg Neurol Int"},{"key":"10.25259\/SNI_692_2022\/ref-12","doi-asserted-by":"crossref","first-page":"e6421","DOI":"10.1097\/MD.0000000000006421","article-title":"Prevalence of complications after surgery in treatment for cervical compressive myelopathy: A meta-analysis for last decade","volume":"96","author":"Wang","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"10.25259\/SNI_692_2022\/ref-13","first-page":"e5279","article-title":"Spinal cord reperfusion injury: Case report, review of the literature, and future treatment strategies","volume":"11","author":"Wiginton","year":"2019","journal-title":"Cureus"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/white-cord-syndrome-following-posterior-decompression-and-fusion-for-severe-opll-and-an-acute-traumatic-cervical-injury-a-case-report-and-review-of-literature\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/white-cord-syndrome-following-posterior-decompression-and-fusion-for-severe-opll-and-an-acute-traumatic-cervical-injury-a-case-report-and-review-of-literature\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,28]],"date-time":"2022-10-28T08:42:43Z","timestamp":1666946563000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/white-cord-syndrome-following-posterior-decompression-and-fusion-for-severe-opll-and-an-acute-traumatic-cervical-injury-a-case-report-and-review-of-literature\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,28]]},"references-count":13,"alternative-id":["10.25259\/SNI_692_2022"],"URL":"https:\/\/doi.org\/10.25259\/sni_692_2022","relation":{},"ISSN":["2152-7806"],"issn-type":[{"value":"2152-7806","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,28]]},"article-number":"501"}}