“White Cord Syndrome” - A Reperfusion Injury Following Laminectomy and Spinal Decompression Surgery - A Case Report and Literature Review

Sep 30, 2026

Uploaded by Jacob

White cord syndrome (WCS) is a rare yet serious postoperative complication marked by new neurological deficits and hyperintense T2-weighted MRI signals after spinal decompression. The mechanism is linked to ischemia–reperfusion injury during restoration of blood flow to chronically ischemic spinal cord tissue, with oxidative stress, microvascular thrombosis, and impaired autoregulation implicated. The report details a 61-year-old Iranian man who developed quadriparesis and paresthesia after posterior decompression surgery, with partial neurologic recovery after immediate high-dose methylprednisolone.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Introduction

White cord syndrome overview

Mechanism and proposed contributing factors

Case presentation and literature review scope

Table 1: Previous cases reported regarding white cord syndrome

Wiley Case Reports in Medicine Volume 2026, Article ID 5539165, 10 pages [https://doi.org/10.1155/carm/5539165](https://doi.org/10.1155/carm/5539165) Case Report “White Cord Syndrome”: A Reperfusion Injury Following Laminectomy and Spinal Decompression Surgery—A Case Report and Literature Review Iran Chanideh , 1 Amirmohammad Khodaei ,2 Masoud Ghadiri ,2 Zeinab Shakibaee Fard ,2 Mohammad Mehdi Falahi Tabar ,2 Arian Yavari 2 , and Sepehr Niktash 2 1 Clinical Research Development Center, Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran 2 Student Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran Correspondence should be addressed to Amirmohammad Khodaei; [amirkhodaei007@gmail.com](amirkhodaei007@gmail.com) Received 17 July 2025; Revised 19 December 2025; Accepted 26 December 2025 Academic Editor: Semonti Nandi Copyright © 2026 Iran Chanideh et al. Case Reports in Medicine published by John Wiley & Sons Ltd. Tis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. White cord syndrome (WCS) is a rare but serious postoperative complication characterized by new neurological defcits and hyperintense signal changes on T2-weighted magnetic resonance imaging (MRI) following spinal decompression surgery. Since it was frst described by Chin et al. in 2013, WCS has been attributed to reperfusion injury resulting from sudden restoration of blood fow to chronically ischemic spinal cord tissue. Oxidative stress, microvascular thrombosis, and impaired autoregulation have been proposed as contributing factors. We report the case of a 61-year-old Iranian man with a history of cervical canal stenosis who developed quadriparesis and paresthesia following posterior decompression surgery. Postoperative MRI revealed hyperintense signals consistent with WCS. High-dose methylprednisolone was administered immediately, leading to partial neurological recovery during hospitalization. Tis case highlights the importance of early recognition and aggressive management of WCS to improve functional outcomes. Raising awareness of this syndrome among spine surgeons is essential for timely diagnosis and management. Keywords: decompression; neurosurgery; reperfusion injury; white cord syndrome 1. Introduction White cord syndrome (WCS) is a rare postoperative complication characterized by acute neurological deterioration and hyperintense T2-weighted magnetic resonance imaging (MRI) signals after spinal decompression in patients with chronic cervical canal stenosis [1] . Te underlying mechanism is believed to involve ischemia–reperfusion injury, which occurs in the absence of direct intraoperative trauma [2] . Additional contributing factors may include occlusion of small spinal arteries, microthrombi formation, oxidative stress, and lipid peroxidation of neuronal membranes [3] . Te term “WCS” was frst introduced by Chin et al. in 2013, referring to the postoperative appearance of bright T2 hyperintensities within the spinal cord, which may be accompanied by severe neurological defcits [4, 5] . Since that initial report, an increasing number of cases have been documented, possibly due to greater awareness of the condition among clinicians. Tis article presents a new case of WCS following posterior cervical decompression and provides a review of 20 previously published cases from 2013 to 2024 (Table 1), aiming to further enhance understanding of this uncommon but clinically signifcant condition. Table 1: Previous cases reported regarding white cord syndrome. | | Year | Age/sex/comorbidity | Preoperative
diagnosis
(initial
diagnosis) | Management
(initial
surgery) | IOM | Neurology
after
surgery | Onset
of defcit | Management
of WCS | Final
clinical
outcome | | --- | --- |

FAQs

What defines white cord syndrome after spinal decompression surgery?

White cord syndrome is characterized by acute neurological deterioration and hyperintense T2-weighted MRI signals following spinal decompression, often in patients with chronic cervical canal stenosis.

How is white cord syndrome thought to occur even without direct intraoperative trauma?

The underlying mechanism is believed to involve ischemia–reperfusion injury, where sudden restoration of blood flow to chronically ischemic spinal tissue leads to oxidative stress and microvascular complications.

What treatment was used in the presented case, and what was the outcome?

High-dose methylprednisolone was administered immediately after surgery, leading to partial neurological recovery during hospitalization.

Sep 30, 2026

Uploaded by Jacob