{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:37:15Z","timestamp":1769726235683,"version":"3.49.0"},"reference-count":66,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"12","license":[{"start":{"date-parts":[[2025,9,22]],"date-time":"2025-09-22T00:00:00Z","timestamp":1758499200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,9,22]]},"abstract":"\n BACKGROUND<\/jats:title>\n White cord syndrome (WCS) is a rare and extremely serious complication that can occur following spinal decompression procedures for severe mostly cervical spinal stenosis. It is often reported immediately after surgery or several hours to days postoperatively and is identified via a diagnosis of exclusion based on new-onset sudden motor weakness after a decompression procedure.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n The authors report the illustrative case of a 54-year-old female patient with WCS, who was managed with surgical intervention, corticosteroid therapy, and mean arterial blood pressure support. Additionally, the authors systematically reviewed an additional 27 cases of WCS documented in the literature.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n A relatively favorable clinical outcome was observed in this patient following surgical intervention combined with corticosteroid therapy and mean blood pressure support. Currently, there are no established guidelines for the treatment of WCS; however, in any patient experiencing sudden neurological deterioration after cervical spinal decompressive surgery\u2014especially when a known cause is unidentified\u2014WCS should be considered as a potential diagnosis, and prompt treatment should be initiated to attempt to improve outcomes.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25542<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25542","type":"journal-article","created":{"date-parts":[[2025,9,23]],"date-time":"2025-09-23T00:27:17Z","timestamp":1758587237000},"source":"Crossref","is-referenced-by-count":1,"title":["White cord syndrome: a rare and challenging diagnosis. Illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7298-3240","authenticated-orcid":true,"given":"Bekir","family":"Rov\u010danin","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina"},{"name":"Faculty of Medicine, University of Sarajevo, Bosnia and Herzegovina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ibrahim","family":"Omerhod\u017ei\u0107","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina"},{"name":"Faculty of Medicine, University of Sarajevo, Bosnia and Herzegovina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amila","family":"Gad\u017eo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Clinical Center University of Sarajevo, Bosnia and Herzegovina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Almir","family":"D\u017eurli\u0107","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0184-1579","authenticated-orcid":true,"given":"Haso","family":"Sefo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adi","family":"Ahmetspahi\u0107","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edin","family":"Hajdarpa\u0161i\u0107","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenan","family":"Arnautovi\u0107","sequence":"additional","affiliation":[{"name":"Semmes Murphey Neurologic and Spine Clinic, Memphis, Tennessee"},{"name":"Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"bib1","series-title":"World Neurosurg","first-page":"194","article-title":"Reperfusion \u201cwhite cord\u201d' syndrome in cervical spondylotic myelopathy: does mean arterial pressure goal make a difference? Additional case and literature review","volume":"137","author":"Mathkour","year":"2020","unstructured":"Mathkour MWerner CRiffle JReperfusion \u201cwhite cord\u201d' syndrome in cervical spondylotic myelopathy: does mean arterial pressure goal make a difference? Additional case and literature review. World Neurosurg. 2020;137:194-199."},{"key":"bib2","series-title":"World Neurosurg","first-page":"33","article-title":"White Cord Syndrome\u201d of acute hemiparesis after posterior cervical decompression and fusion for chronic cervical stenosis","volume":"113","author":"Antwi","year":"2018","unstructured":"Antwi PGrant RKuzmik GAbbed K. \u201cWhite Cord Syndrome\u201d of acute hemiparesis after posterior cervical decompression and fusion for chronic cervical stenosis. World Neurosurg. 2018;113:33-36."},{"issue":"8","key":"bib3","series-title":"J Spinal Disord Tech","first-page":"565","article-title":"Major neurologic deficit immediately after adult spinal surgery: incidence and etiology over 10 years at a single training institution","volume":"22","author":"Cramer","year":"2009","unstructured":"Cramer DEMaher PCPettigrew DBKuntz Ct.Major neurologic deficit immediately after adult spinal surgery: incidence and etiology over 10 years at a single training institution. J Spinal Disord Tech. 2009;22(8):565-570."},{"issue":"11","key":"bib4","series-title":"Spine J","first-page":"1611","article-title":"Perioperative neurologic complications during spinal fusion surgery: incidence and trends","volume":"17","author":"Thirumala","year":"2017","unstructured":"Thirumala PZhou JNatarajan PPerioperative neurologic complications during spinal fusion surgery: incidence and trends. Spine J. 2017;17(11):1611-1624."},{"key":"bib5","series-title":"Case Rep Orthop","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","unstructured":"Chin KRSeale JCumming V. \u201cWhite cord syndrome\u201d of acute tetraplegia after anterior cervical decompression and fusion for chronic spinal cord compression: a case report. Case Rep Orthop. 2013;2013:697918."},{"key":"bib6","series-title":"Surg Neurol Int","article-title":"White cord syndrome: a devastating complication of spinal decompression surgery","volume":"9","author":"Vinodh","year":"2018","unstructured":"Vinodh VPRajapathy SKSellamuthu PKandasamy R.White cord syndrome: a devastating complication of spinal decompression surgery. Surg Neurol Int. 2018;9:136."},{"issue":"4","key":"bib7","series-title":"Cureus","first-page":"e38177","article-title":"White cord syndrome: a treatment dilemma","volume":"15","author":"Yen Hsin","year":"2023","unstructured":"Yen Hsin LSamynathan C VVYilun H.White cord syndrome: a treatment dilemma. Cureus. 2023;15(4):e38177."},{"issue":"5","key":"bib8","series-title":"Pediatr Neurosurg","first-page":"477","article-title":"White cord syndrome after thoracic cord decompression in a pediatric patient","volume":"56","author":"Carter","year":"2021","unstructured":"Carter LMPelargos PEGernsback JE.White cord syndrome after thoracic cord decompression in a pediatric patient. Pediatr Neurosurg. 2021;56(5):477-481."},{"key":"bib9","series-title":"Int J Surg","first-page":"105906","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"88","author":"Page","year":"2021","unstructured":"Page MJMcKenzie JEBossuyt PMThe PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906."},{"issue":"19","key":"bib10","series-title":"J Neurosurg Case Lessons","first-page":"CASE2113","article-title":"Delayed-onset white cord syndrome after anterior and posterior cervical decompression surgery for symptomatic ossification of spinal ligaments: illustrative cases","volume":"1","author":"Singh","year":"2021","unstructured":"Singh RDArts MPde Ruiter GCW.Delayed-onset white cord syndrome after anterior and posterior cervical decompression surgery for symptomatic ossification of spinal ligaments: illustrative cases. 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Radiol Case Rep. 2020;15(11):2343-2347."},{"issue":"3","key":"bib13","series-title":"Cureus","first-page":"e55353","article-title":"White cord syndrome following cervical surgery in a patient with Klippel-Feil syndrome: a case report","volume":"16","author":"Chatzikomninos","year":"2024","unstructured":"Chatzikomninos IPappa EZafeiris CPWhite cord syndrome following cervical surgery in a patient with Klippel-Feil syndrome: a case report. Cureus. 2024;16(3):e55353."},{"issue":"2","key":"bib14","series-title":"Korean J Neurotrauma","first-page":"380","article-title":"White cord syndrome: a reperfusion injury following spinal decompression surgery","volume":"18","author":"So","year":"2022","unstructured":"So JSKim YJChung J.White cord syndrome: a reperfusion injury following spinal decompression surgery. Korean J Neurotrauma. 2022;18(2):380-386."},{"issue":"2","key":"bib15","series-title":"Heliyon","first-page":"e03414","article-title":"The safety and efficacy of steroid treatment for acute spinal cord injury: a systematic review and meta-analysis","volume":"6","author":"Sultan","year":"2020","unstructured":"Sultan ILamba NLiew AThe safety and efficacy of steroid treatment for acute spinal cord injury: a systematic review and meta-analysis. Heliyon. 2020;6(2):e03414."},{"key":"bib16","series-title":"Front Neurol","first-page":"1220598","article-title":"Posterior spinal decompression in adults with spinal cord injury without traumatic compromise of the spinal canal: what is the data?","volume":"14","author":"Solou","year":"2023","unstructured":"Solou MPolitis AAYdreos \u0399Posterior spinal decompression in adults with spinal cord injury without traumatic compromise of the spinal canal: what is the data? Front Neurol. 2023;14:1220598."},{"issue":"6","key":"bib17","series-title":"J Orthop Case Rep","first-page":"138","article-title":"Recovery from white cord syndrome after anterior cervical corpectomy and fusion: a case report","volume":"13","author":"Ranjan","year":"2023","unstructured":"Ranjan SDebbarma SSkandh AReang S.Recovery from white cord syndrome after anterior cervical corpectomy and fusion: a case report. J Orthop Case Rep. 2023;13(6):138-143."},{"issue":"9","key":"bib18","series-title":"Cureus","first-page":"e28715","article-title":"Cervical spinal cord ischemic reperfusion injury: a comprehensive narrative review of the literature and case presentation","volume":"14","author":"Algahtani","year":"2022","unstructured":"Algahtani AYBamsallm MAlghamdi KTAlzahrani MAhmed J.Cervical spinal cord ischemic reperfusion injury: a comprehensive narrative review of the literature and case presentation. Cureus. 2022;14(9):e28715."},{"issue":"3","key":"bib19","series-title":"Asian J Neurosurg","first-page":"756","article-title":"White Cord Syndrome\u201d of acute tetraplegia after posterior cervical decompression and resulting hypoxic brain injury","volume":"15","author":"Kalidindi","year":"2020","unstructured":"Kalidindi KKVSath S. \u201cWhite Cord Syndrome\u201d of acute tetraplegia after posterior cervical decompression and resulting hypoxic brain injury. Asian J Neurosurg. 2020;15(3):756-758."},{"issue":"1","key":"bib20","series-title":"Int J Emerg Med","first-page":"39","article-title":"Cervical cord reperfusion injury: a rare complication of spine surgery","volume":"15","author":"Hasan","year":"2022","unstructured":"Hasan WKhan KAlomani N.Cervical cord reperfusion injury: a rare complication of spine surgery. Int J Emerg Med. 2022;15(1):39."},{"issue":"1","key":"bib21","series-title":"Exp Ther Med","first-page":"71","article-title":"Lateonset white cord syndrome following anterior cervical discectomy and fusion: a case report","volume":"25","author":"Lei","year":"2023","unstructured":"Lei CZGong DJZhou YF.Lateonset white cord syndrome following anterior cervical discectomy and fusion: a case report. Exp Ther Med. 2023;25(1):71."},{"key":"bib22","series-title":"Spinal Cord Ser Cases","first-page":"28","article-title":"Late-onset \u201cwhite cord syndrome\u201d in an elderly patient after posterior cervical decompression and fusion: a case report","volume":"5","author":"Papaioannou","year":"2019","unstructured":"Papaioannou IRepantis TBaikousis AKorovessis P.Late-onset \u201cwhite cord syndrome\u201d in an elderly patient after posterior cervical decompression and fusion: a case report. Spinal Cord Ser Cases. 2019;5:28."},{"issue":"5","key":"bib23","series-title":"Neurosurgery","first-page":"713","article-title":"Guidelines for the use of electrophysiological monitoring for surgery of the human spinal column and spinal cord","volume":"81","author":"Hadley","year":"2017","unstructured":"Hadley MNShank CDRozzelle CJWalters BC.Guidelines for the use of electrophysiological monitoring for surgery of the human spinal column and spinal cord. Neurosurgery. 2017;81(5):713-732."},{"key":"bib24","series-title":"Interdiscip Neurosurg","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","unstructured":"Giammalva GRMaugeri RGraziano FWhite cord syndrome after non-contiguous double-level anterior cervical decompression and fusion (ACDF): a \u201cno reflow phenomenon\u201d? Interdiscip Neurosurg. 2017;7:47-49."},{"issue":"7","key":"bib25","series-title":"Cureus","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","unstructured":"Wiginton JGBrazdzionis JMohrdar CSweiss RLawandy S.Spinal cord reperfusion injury: case report, review of the literature, and future treatment strategies. Cureus. 2019;11(7):e5279."},{"issue":"1","key":"bib26","series-title":"BMC Musculoskelet Disord","first-page":"157","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","unstructured":"Jun DSBaik JMLee SK.A case report: white cord syndrome following anterior cervical discectomy and fusion: importance of prompt diagnosis and treatment. BMC Musculoskelet Disord. 2020;21(1):157."},{"issue":"5","key":"bib27","series-title":"Exp Ther Med","first-page":"90","article-title":"White cord syndrome\u2019, a rare but disastrous complication of transient paralysis after posterior cervical decompression for severe cervical spondylotic myelopathy and spinal stenosis: a case report","volume":"20","author":"Liao","year":"2020","unstructured":"Liao YXHe SSHe ZM. \u2018White cord syndrome\u2019, a rare but disastrous complication of transient paralysis after posterior cervical decompression for severe cervical spondylotic myelopathy and spinal stenosis: a case report. Exp Ther Med. 2020;20(5):90."},{"issue":"2","key":"bib28","series-title":"JBJS Case Connect","article-title":"White cord syndrome and acute tetraplegia after posterior cervical decompression: a case report","volume":"11","author":"Segal","year":"2021","unstructured":"Segal DNLunati MPKukowski NRMichael KW.White cord syndrome and acute tetraplegia after posterior cervical decompression: a case report. JBJS Case Connect. 2021;11(2)."},{"issue":"suppl","key":"bib29","series-title":"Neurol India","first-page":"S306","article-title":"White Cord Syndrome\u2019: a rare catastrophic complication following anterior cervical discectomy and fusion","volume":"70","author":"Goyal","year":"2022","unstructured":"Goyal NChaturvedi JKandwal PGupta PKaushal AKumar M. \u2018White Cord Syndrome\u2019: a rare catastrophic complication following anterior cervical discectomy and fusion. Neurol India. 2022;70(suppl):S306-S309."},{"key":"bib30","series-title":"Surg Neurol Int","first-page":"501","article-title":"White cord syndrome following posterior decompression and fusion for severe OPLL and an acute traumatic cervical injury\u2014a case report and review of literature","volume":"13","author":"Dahapute","year":"2022","unstructured":"Dahapute AABalasubramanian SGAnnis P.White cord syndrome following posterior decompression and fusion for severe OPLL and an acute traumatic cervical injury\u2014a case report and review of literature. Surg Neurol Int. 2022;13:501."},{"issue":"7","key":"bib31","series-title":"Cureus","first-page":"e65071","article-title":"Delayed lower extremity monoplegia after anterior cervical discectomy and fusion: a report of a rare case of cervical spinal ischemic reperfusion injury","volume":"16","author":"Zach","year":"2024","unstructured":"Zach RVAbdulhamid MValizadeh NZach V.Delayed lower extremity monoplegia after anterior cervical discectomy and fusion: a report of a rare case of cervical spinal ischemic reperfusion injury. Cureus. 2024;16(7):e65071."},{"issue":"9","key":"bib32","series-title":"J Orthop Case Rep","first-page":"14","article-title":"White cord syndrome following long posterior decompression","volume":"14","author":"Jain","year":"2024","unstructured":"Jain MTripathy SKVarghese PNaik SSahoo DRSingh AK.White cord syndrome following long posterior decompression. J Orthop Case Rep. 2024;14(9):14-18."},{"issue":"1","key":"bib33","series-title":"J Med Case Rep","first-page":"527","article-title":"Reperfusion injury case following cervical fusion with OPLL: a case report and literature review","volume":"18","author":"Mahamid","year":"2024","unstructured":"Mahamid AZahalka SMaman DAlfandari LKeren ABehrbalk E.Reperfusion injury case following cervical fusion with OPLL: a case report and literature review. J Med Case Rep. 2024;18(1):527."},{"key":"bib1","series-title":"World Neurosurg","first-page":"194","article-title":"Reperfusion \u201cwhite cord\u201d' syndrome in cervical spondylotic myelopathy: does mean arterial pressure goal make a difference? Additional case and literature review","volume":"137","author":"Mathkour","year":"2020","unstructured":"Mathkour MWerner CRiffle JReperfusion \u201cwhite cord\u201d' syndrome in cervical spondylotic myelopathy: does mean arterial pressure goal make a difference? Additional case and literature review. World Neurosurg. 2020;137:194-199."},{"key":"bib2","series-title":"World Neurosurg","first-page":"33","article-title":"White Cord Syndrome\u201d of acute hemiparesis after posterior cervical decompression and fusion for chronic cervical stenosis","volume":"113","author":"Antwi","year":"2018","unstructured":"Antwi PGrant RKuzmik GAbbed K. \u201cWhite Cord Syndrome\u201d of acute hemiparesis after posterior cervical decompression and fusion for chronic cervical stenosis. World Neurosurg. 2018;113:33-36."},{"issue":"8","key":"bib3","series-title":"J Spinal Disord Tech","first-page":"565","article-title":"Major neurologic deficit immediately after adult spinal surgery: incidence and etiology over 10 years at a single training institution","volume":"22","author":"Cramer","year":"2009","unstructured":"Cramer DEMaher PCPettigrew DBKuntz Ct.Major neurologic deficit immediately after adult spinal surgery: incidence and etiology over 10 years at a single training institution. J Spinal Disord Tech. 2009;22(8):565-570."},{"issue":"11","key":"bib4","series-title":"Spine J","first-page":"1611","article-title":"Perioperative neurologic complications during spinal fusion surgery: incidence and trends","volume":"17","author":"Thirumala","year":"2017","unstructured":"Thirumala PZhou JNatarajan PPerioperative neurologic complications during spinal fusion surgery: incidence and trends. Spine J. 2017;17(11):1611-1624."},{"key":"bib5","series-title":"Case Rep Orthop","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","unstructured":"Chin KRSeale JCumming V. \u201cWhite cord syndrome\u201d of acute tetraplegia after anterior cervical decompression and fusion for chronic spinal cord compression: a case report. 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Heliyon. 2020;6(2):e03414."},{"key":"bib16","series-title":"Front Neurol","first-page":"1220598","article-title":"Posterior spinal decompression in adults with spinal cord injury without traumatic compromise of the spinal canal: what is the data?","volume":"14","author":"Solou","year":"2023","unstructured":"Solou MPolitis AAYdreos \u0399Posterior spinal decompression in adults with spinal cord injury without traumatic compromise of the spinal canal: what is the data? Front Neurol. 2023;14:1220598."},{"issue":"6","key":"bib17","series-title":"J Orthop Case Rep","first-page":"138","article-title":"Recovery from white cord syndrome after anterior cervical corpectomy and fusion: a case report","volume":"13","author":"Ranjan","year":"2023","unstructured":"Ranjan SDebbarma SSkandh AReang S.Recovery from white cord syndrome after anterior cervical corpectomy and fusion: a case report. J Orthop Case Rep. 2023;13(6):138-143."},{"issue":"9","key":"bib18","series-title":"Cureus","first-page":"e28715","article-title":"Cervical spinal cord ischemic reperfusion injury: a comprehensive narrative review of the literature and case presentation","volume":"14","author":"Algahtani","year":"2022","unstructured":"Algahtani AYBamsallm MAlghamdi KTAlzahrani MAhmed J.Cervical spinal cord ischemic reperfusion injury: a comprehensive narrative review of the literature and case presentation. Cureus. 2022;14(9):e28715."},{"issue":"3","key":"bib19","series-title":"Asian J Neurosurg","first-page":"756","article-title":"White Cord Syndrome\u201d of acute tetraplegia after posterior cervical decompression and resulting hypoxic brain injury","volume":"15","author":"Kalidindi","year":"2020","unstructured":"Kalidindi KKVSath S. \u201cWhite Cord Syndrome\u201d of acute tetraplegia after posterior cervical decompression and resulting hypoxic brain injury. 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