1129 - White Cord Syndrome as a Complication of Posterior Thoracic Decompression Surgery

Case Diagnosis: Ischemic thoracic spinal cord reperfusion injury as a complication of posterior decompression surgery

Case Description: A 62-year-old male presented with worsening numbness and weakness of bilateral lower extremities and was found to have severe central canal stenosis at T6-T7 with significant cord compression. He underwent posterior decompression surgery, which was complicated by ischemic reperfusion injury to the affected area, resulting in incomplete paraplegia and bladder/bowel incontinence. The remainder of his hospital course was uncomplicated, and he was discharged to inpatient rehab. He initially required up to maximum assistance with mobility and ADLs. With intensive therapy, he gained some movement and sensation back in both lower extremities, right greater than left. He was placed on timed voids and a scheduled bowel program and experienced improvement in bladder and bowel function. He was discharged from inpatient rehab independent with mobility and ADLs from a wheelchair base.

Discussions: Paralysis after spinal surgery is one of the most feared complications and is most often caused by epidural hematoma. In rare cases, when there is an absence of a hematoma or fluid collection on MRI, “White Cord Syndrome” can be the cause. This is likely attributed to rapid cord expansion and reperfusion to the affected area. Most documented cases are related to surgery in the cervical region, rather than thoracic. Additionally, the prognosis for recovery is difficult to estimate.

Conclusions: By presenting this case and the subsequent rehab course, we hope to bring attention to this rare complication, especially as a result of surgery in the thoracic region rather than cervical. This can help surgeons have a more comprehensive discussion with their patients in the informed consent process, help physiatrists be more aware of the prognosis for recovery, and help contribute to future meta-analyses on the subject.