Abstract
Paralysis is the most feared postoperative complication of ACDF and occurs most often due to an epidural hematoma. In the absence of a clear etiology, inadequate decompression or vascular insult such as ischemia/reperfusion injury are the usual suspects. Herewith we report a case of complete loss of somatosensory evoked potentials (SSEPs) during elective ACDF at C4-5 and C5-6 followed by postoperative C6 incomplete tetraplegia without any discernible technical cause. A postoperative MRI demonstrated a large area of high signal changes on T2-weighted MRI intrinsic to the cord “white cord syndrome” but no residual compression. This was considered consistent with spinal cord gliosis with possible acute edema. The acute decompression of the herniated disc resulted in cord expansion and rush-in reperfusion. We postulate that this may have led to disruption in the blood brain barrier (BBB) and triggered a cascade of reperfusion injuries resulting in acute neurologic dysfunction. At 16 months postoperatively our patient is recovering slowly and is now a Nurick Grade 4.
Highlights
Anterior cervical decompression and fusion (ACDF) are commonly performed procedures for conditions resulting in symptomatic nerve root and/or spinal compression anteriorly
We report a case of complete loss of somatosensory evoked potentials (SSEPs) during elective ACDF at C4-5 and C5-6 followed by postoperative C6 incomplete tetraplegia without any discernible technical cause
A postoperative magnetic resonance imaging (MRI) demonstrated a large area of high signal changes on T2-weighted MRI intrinsic to the cord “white cord syndrome” but no residual compression. is was considered consistent with spinal cord gliosis with possible acute edema. e acute decompression of the herniated disc resulted in cord expansion and rush-in reperfusion
Summary
Anterior cervical decompression and fusion (ACDF) are commonly performed procedures for conditions resulting in symptomatic nerve root and/or spinal compression anteriorly. Paralysis is most o en due to an epidural hematoma, but in the absence of clear etiology, inadequate decompression or vascular insult such as ischemia/reperfusion injury possibly due to oxygenderived free radical damage [6,7,8] are the usual suspects. C5-6 followed by postoperative C6 incomplete tetraplegia without any discernable technical cause. We describe this occurrence as a “white cord syndrome” because of the postoperative appearance of a large area of cord edema behind the massive herniated disc seen on sagittal T2-weighted magnetic resonance imaging (MRI). A 59-year-old male patient was referred to us with a MRI diagnosis of a large C5-6 herniated disc causing severe cord compression, neck pain, radiculomyelopathy, and ataxia. A 59-year-old male patient was referred to us with a MRI diagnosis of a large C5-6 herniated disc causing severe cord compression, neck pain, radiculomyelopathy, and ataxia. e patient gave a seven-month history of neck pain with shoulder radiation, pain in the lower back radiating to both
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