Reperfusion 'White Cord’’ Syndrome in Cervical Spondylotic Myelopathy: Does Mean Arterial Pressure Goal Make a Difference? Additional Case and Literature Review
| Autor: | Christopher M. Maulucci, Jonathan Riffle, Mansour Mathkour, Tyler Scullen, Aaron S. Dumont, Cassidy Werner, Robert F. Dallapiazza |
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| Rok vydání: | 2020 |
| Předmět: |
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medicine.medical_specialty Cord Decompression Dexamethasone Neurosurgical Procedures 03 medical and health sciences Myelopathy Postoperative Complications Spinal Stenosis 0302 clinical medicine medicine Humans Arterial Pressure Glucocorticoids Stroke Physical Therapy Modalities Aged medicine.diagnostic_test Spinal Cord Ischemia business.industry Magnetic resonance imaging Decompression Surgical medicine.disease Spinal cord Magnetic Resonance Imaging Hyperintensity Surgery Spinal Fusion medicine.anatomical_structure Reperfusion Injury 030220 oncology & carcinogenesis Cervical Vertebrae Spondylosis Neurology (clinical) business Spinal Cord Compression Myelomalacia 030217 neurology & neurosurgery |
| Zdroj: | World Neurosurgery. 137:194-199 |
| ISSN: | 1878-8750 |
| DOI: | 10.1016/j.wneu.2020.01.062 |
| Popis: | Background “White cord syndrome” or reperfusion injury of chronically ischemic areas of the spinal cord is a relatively newly defined etiology in spinal surgery. This rare syndrome is characterized as unexplained new neurological deficits after an anterior or posterior decompressive cervical procedure. The radiographic hallmark is the presence of hyperintense T2 intramedullary signal change after a decompressive procedure without other pathologic changes. We present an additional case of this complication and review the literature. Case Presentation A 79-year-old man presented in consultation for advanced cervical myelopathy. He had experienced 2–3 months of worsening gait instability and issues with hand dexterity. Three days prior to presentation his lower extremity weakness had worsened to the point he was no longer able to ambulate. Magnetic resonance imaging (MRI) of the cervical spine demonstrated severe central canal stenosis secondary to spondylosis with T2 hyperintensity correlating to myelomalacia. He underwent an uncomplicated posterior cervical decompression and fusion and awoke with worsened right hemiparesis from neurologic baseline. Brain MRI was negative for stroke and MRI of the cervical spine showed successful decompression but worsening T2 signal changes. The patient's weakness improved with maintaining mean arterial pressure (MAP) goal, steroids, and physical therapy. He was eventually discharged to an acute rehabilitation facility. Conclusions White cord syndrome is rare and has only been reported in 5 other patients upon review of the literature. Our case is the 7th general and the 5th after posterior cervical decompression. The pathophysiology is thought to be due to a reperfusion type injury of chronically ischemic areas of the spinal cord. All but one patient to date have improved after MAP goal, steroid administration therapy, and acute rehabilitation, including our patients. Spine surgeons should be aware of this potentially devastating complication and how to properly manage these patients' postoperative care. |
| Databáze: | OpenAIRE |
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