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Case Reports in Orthopedics
Volume 2013 (2013), Article ID 697918, 5 pages
Case Report

“White Cord Syndrome” of Acute Tetraplegia after Anterior Cervical Decompression and Fusion for Chronic Spinal Cord Compression: A Case Report

1Charles E. Schmidt College of Medicine, Florida Atlantic University and Institute for Modern & Innovative Surgery (iMIS), 1100 W. Oakland Park Boulevard, Suite No. 3, Fort Lauderdale, FL 33311, USA
2iMIS Surgery, 1100 W. Oakland Park Boulevard, Suite No. 3, Fort Lauderdale, FL 33311, USA
3LES Society, 300 E. Oakland Park Boulevard, Suite 502, Fort Lauderdale, FL 33334, USA

Received 11 December 2012; Accepted 31 December 2012

Academic Editors: Y. J. Chen, K. Erler, R. A. Gosselin, and M. Pirpiris

Copyright © 2013 Kingsley R. Chin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.