White Cord Syndrome Following Anterior Cervical Discectomy and Fusion: A Case of Transient Quadriplegia With Complete Neurological Recovery

TL;DR

A 47-year-old man developed temporary quadriplegia after cervical spine surgery but made a full recovery, highlighting a rare condition called white cord syndrome.

Contribution

This case report adds to the understanding of white cord syndrome as a rare postoperative complication of spinal decompression surgery.

Findings

The patient experienced acute quadriplegia after ACDF, diagnosed as white cord syndrome via MRI.

Supportive care led to partial recovery within 3 days and complete recovery by 5 months post-surgery.

The case emphasizes the importance of recognizing and managing white cord syndrome after spinal surgery.

Abstract

Cervical myelopathy is a progressive degenerative condition characterized by spinal cord compression, which often requires surgery to avoid further stepwise deterioration of this pathology. While anterior cervical discectomy and fusion (ACDF) is a well-established treatment, postoperative neurological deficits, although rare, remain a significant concern. White cord syndrome (WCS) is an uncommon cause of acute neurological deficit following spine surgery that is attributed to a reperfusion injury following decompression of a chronically impinged spinal cord. We present the case of a 47-year-old male with a preoperative diagnosis of cervical myelopathy (Nurick 4) who developed acute quadriplegia following ACDF. Initial imaging ruled out common postoperative complications, such as hematoma or hardware malposition, and an MRI revealed hyperintense signals consistent with WCS. Supportive management led to partial neurological recovery by postoperative day 3, followed by complete neurological recovery and marked functional and strength improvement beyond baseline by the five-month follow-up. This report aims to present a case of WCS, a rare complication following spinal decompression surgery, highlighting its diagnosis, management, and outcome.

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