Study design Case report and review of literature. Objective To report a rare complication of anterior cervical decompression and fusion (ACDF) in a patient with severe cervical cord compression and review of relevant literature. Introduction The white cord syndrome is a very rare condition characterized by an ischemic-edematous lesion of the spinal cord following a surgical procedure, lacking intra o perioperative surgical or anesthesiological complications. Case report A 64-years old male affected by a severe cervical stenosis at multiple levels, with voluminous C3–C4 and C5–C6 disc herniations associated to T2-hyperintense myelomalacic area at C3–C4 level was admitted to our Unit of Neurosurgery in July 2015. A double-level anterior cervical decompression and fusion (ACDF) procedure was performed without intraoperative complications and, in the immediate post-operative period, the patient developed a severe motor weakness to four limbs. The post-operative cervical spine MRI revealed an extension of the hyperintensity on the C5–C6 level. In the immediate post-operative course high doses of dexamethasone were administered, in order to treat the secondary spinal damage. The patient was, after few days, transferred to a Rehabilitation Unit where a partial improvement of the motor weakness was gradually observed. We report the second case of this complication in Literature to support the theory of a possible reperfusion injury after a double ACDF. We speculate an ethiologic mechanism similar to a long-term no-reflow phenomenon, likely during the post-ischemic period in myocardial or cerebral infarction. Conclusions Despite the pathophysiology of non-reflow phenomenon is not widely known, we suspect that an improper blood flow after the double-level discectomy could have led to the changes in medullar hemodynamics.

Giammalva G.R., Maugeri R., Graziano F., Guli C., Giugno A., Basile L., et al. (2017). White cord syndrome after non-contiguous double-level anterior cervical decompression and fusion (ACDF): A “no reflow phenomenon”?. INTERDISCIPLINARY NEUROSURGERY, 7, 47-49 [10.1016/j.inat.2016.12.001].

White cord syndrome after non-contiguous double-level anterior cervical decompression and fusion (ACDF): A “no reflow phenomenon”?

Giammalva G. R.;Giugno A.;Iacopino D.
2017

Abstract

Study design Case report and review of literature. Objective To report a rare complication of anterior cervical decompression and fusion (ACDF) in a patient with severe cervical cord compression and review of relevant literature. Introduction The white cord syndrome is a very rare condition characterized by an ischemic-edematous lesion of the spinal cord following a surgical procedure, lacking intra o perioperative surgical or anesthesiological complications. Case report A 64-years old male affected by a severe cervical stenosis at multiple levels, with voluminous C3–C4 and C5–C6 disc herniations associated to T2-hyperintense myelomalacic area at C3–C4 level was admitted to our Unit of Neurosurgery in July 2015. A double-level anterior cervical decompression and fusion (ACDF) procedure was performed without intraoperative complications and, in the immediate post-operative period, the patient developed a severe motor weakness to four limbs. The post-operative cervical spine MRI revealed an extension of the hyperintensity on the C5–C6 level. In the immediate post-operative course high doses of dexamethasone were administered, in order to treat the secondary spinal damage. The patient was, after few days, transferred to a Rehabilitation Unit where a partial improvement of the motor weakness was gradually observed. We report the second case of this complication in Literature to support the theory of a possible reperfusion injury after a double ACDF. We speculate an ethiologic mechanism similar to a long-term no-reflow phenomenon, likely during the post-ischemic period in myocardial or cerebral infarction. Conclusions Despite the pathophysiology of non-reflow phenomenon is not widely known, we suspect that an improper blood flow after the double-level discectomy could have led to the changes in medullar hemodynamics.
Settore MED/27 - Neurochirurgia
Giammalva G.R., Maugeri R., Graziano F., Guli C., Giugno A., Basile L., et al. (2017). White cord syndrome after non-contiguous double-level anterior cervical decompression and fusion (ACDF): A “no reflow phenomenon”?. INTERDISCIPLINARY NEUROSURGERY, 7, 47-49 [10.1016/j.inat.2016.12.001].
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10447/484792
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