“White Cord Syndrome” of Acute Hemiparesis After Posterior Cervical Decompression and Fusion for Chronic Cervical Stenosis

“White cord syndrome” is a very rare condition thought to be due to acute reperfusion of chronically ischemic areas of the spinal cord. Its hallmark is the presence of intramedullary hyperintense signal on T2-weighted magnetic resonance imaging sequences in a patient with unexplained neurologic deficits following spinal cord decompression surgery. The syndrome is rare and has been reported previously in 2 patients following anterior cervical decompression and fusion. We report an additional case of this complication. A 68-year-old man developed acute left-sided hemiparesis after posterior cervical decompression and fusion for cervical spondylotic myelopathy. The patient improved with high-dose steroid therapy. The rare white cord syndrome following either anterior cervical decompression and fusion or posterior cervical decompression and fusion may be due to ischemic-reperfusion injury sustained by chronically compressed parts of the spinal cord. In previous reports, patients have improved following steroid therapy and acute rehabilitation. •White cord syndrome manifests as acute neurologic deficits after cervical decompression surgery.•New hyperintensity on T2 MRI of the cervical cord is suggestive of the syndrome.•Ischemic-reperfusion injury is a likely mechanism.•High-dose steroid therapy and acute rehabilitation prove beneficial.