Reperfusion Injury in the Cord—Rare Case of Pediatric White Cord Syndrome

Abstract

Background: Postoperative neurological deficits following spinal decompression are often caused due to an expanding hematoma or other iatrogenic injuries. When a definitive etiology could not be identified, it may rarely be related to a reperfusion injury. Such unexplained neurological deficits are often associated with the presence of cord signal changes on imaging. It is assumed to result from ischemia-reperfusion injury and is often designated as “white cord syndrome” due to its imaging appearance. Such a diagnosis is made after excluding other differentials. Outcomes are variable based on the current literature. We report a patient with possible white cord syndrome following decompression and excision of cervicodorsal osteochondroma. Case Description: In this case report, we present a young patient who was admitted with slowly progressive paraplegia, and initial imaging showed C7-D1 pedunculated osteochondroma. He underwent an uneventful spinal laminectomy accompanied by tumor excision. In the immediate postoperative period, the patient became paraplegic and a follow-up magnetic resonance imaging was taken. It showed re-expansion of cord in the region of compression by the mass lesion at C7-D1 level with interval abnormal T2/IR hyper intensity extending from C6 to D1 levels. Conclusion: White cord syndrome is an extremely rare condition. It is postulated to be caused by reperfusion injury to the cord within areas of chronic ischemia due to compressive causes. We describe a child with white cord syndrome following decompression and excision of an osteochondroma.