white cord syndrome after non-contiguous double-level anterior cervical decompression and fusion (acdf): a “no reflow phenomenon”?
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2017
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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.
| Reference Key |
giammalva2017interdisciplinarywhite
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| Authors | ;Giuseppe Roberto Giammalva;Rosario Maugeri;Francesca Graziano;Carlo Gulì;Antonella Giugno;Luigi Basile;Domenico Gerardo Iacopino |
| Journal | advances in materials science and engineering |
| Year | 2017 |
| DOI |
10.1016/j.inat.2016.12.001
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| URL | |
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