{"id":"72104417-0ab7-4a36-ac86-9b7609de924f","slug":"reperfusion-injury-rpi-white-cord-syndrome-wcs-due-to-cervical-spine-surgery-a-diagnosis-of-exclusion","title":"Reperfusion Injury (RPI)/White Cord Syndrome (WCS) Due to Cervical Spine Surgery: A Diagnosis of Exclusion","authors":["Nancy E. Epstein"],"abstract":"Background: Following acute cervical spinal cord decompression, a subset of patients may develop acute postoperative paralysis due to Reperfusion Injury (RPI)/White Cord Syndrome (WCS). Pathophysiologically, this occurs due to the immediate restoration of normal blood flow to previously markedly compressed, and under-perfused/ischemic cord tissues. On emergent postoperative MR scans, the classical findings for RPI/ WCS include new or expanded, and focal or diffuse intramedullary hyperintense cord signals consistent with edema/ischemia, swelling, and/or intrinsic hematoma. To confirm RPI/WCS, MR studies must exclude extrinsic cord pathology (e.g. extramedullary hematomas, new/residual compressive disease, new graft/vertebral fracture etc.) that may warrant additional cervical surgery to avoid permanent neurological sequelae. Methods: In the English literature (i.e. excluding 2 Japanese studies), 9 patients were identified with postoperative RPI/WCS following cervical surgical procedures. For 7 patients, new acute postoperative neurological deficits were appropriately attributed to MR-documented RPI/WCS syndromes (i.e. hyperintense cord signals). However, for 2 patients who neurologically worsened, MR studies demonstrated residual extrinsic disease (e.g. stenosis and OPLL) warranting additional surgery; therefore, these 2 patients did not meet the criteria for RPI/WCS. Results: The diagnosis of RPI/WCS is one of exclusion. It is critical to rule out residual extrinsic cord compression where secondary surgery may improve/resolve neurological deficits. Conclusions: Patients with acute postoperative neurological deficits following cervical spine surgery must undergo MR studies to rule out extrinsic cord pathology before being diagnosed with RPI/WCS. Notably, 2 of the 9 cases of RPI/WCS reported in the literature required additional surgery to address stenosis and OPLL, and therefore, did not have the RPI/WCS syndromes.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/72104417-0ab7-4a36-ac86-9b7609de924f/featured/hero-1781563107271.png","publishDate":"2020-10-02T00:00:00.000Z","doi":"10.25259/SNI_555_2020","categories":["Spine","Commentary"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2020/10/10302/SNI-11-320.pdf"}