Abstract Details

Title White Cord Syndrome: a Rare Complication of Cervical Decompression and a Mimicker of Neurosarcoidosis

Topic Autoimmune Neurology

Presentation(s) P6 - Poster Session 6 (11:45 AM-12:45 PM)

Poster/Presentation
Number 8-011

Objective We describe 2 cases of worsening myelopathy after decompression cervical spine surgeries consistent with white cord syndrome (WCS).

Background

WCS is a rare complication after cervical decompression surgeries thought to represent reperfusion injury to the chronically compressed and ischemic areas of spinal cord associated with increased production of inflammatory cytokines (TNF, IL-1B). Data on risk factors, management and outcomes are scarce with debatable role of high-dose steroids.

Design/Methods N/A

Results Case 1: 43-year-old man developed new sensory level, bladder dysfunction and gait impairment two weeks after decompressive laminectomy for symptomatic severe C5-C6 cervical stenosis. His MRI demonstrated longitudinally extensive (C4-C6) T2 hyperintense cord signal with enhancement and edema. Case 2 highlights a 64-year-old man with severe C5-C6 cervical stenosis and progressive longitudinally extensive myelopathy (C2-T2) with enhancement treated with PLEX and steroids with no response. He then underwent anterior cervical decompression and fusion while on high-dose steroids with minimal improvement but had worsening of clinical symptoms and MRI as steroids were discontinued. Both cases had extensive workup for inflammatory, autoimmune, neoplastic and vascular etiologies which was unrevealing. Neurosarcoidosis was favored given longitudinally extensive persistently enhancing lesions; immunosuppression was pursued (steroids, infliximab, methotrexate, mycophenolate mofetil) with resolution of enhancement on MRI but minimal clinical improvement. Patients remained stable over the years with evidence of myelomalacia. Given clinical trajectory WCS was favored as final diagnosis in both cases.

Conclusions WCS is an early neurological complication of cervical decompression surgeries often manifesting as longitudinally extensive myelitis minimally responsive to immunotherapy leading to permanent deficits. Steroids may be beneficial, as we witnessed delayed clinical onset in a patient who was on high-dose steroids during the surgery. Given pathogenesis, there might be a role for TNF-a inhibitors early in the disease, but long-term immunotherapy is not indicated.

Authors/Disclosures
Marina Buciuc, MD PRESENTER	Dr. Buciuc has nothing to disclose.
Gina S. Perez-Giraldo, MD	Dr. Perez-Giraldo has received personal compensation for serving as an employee of TG therapeutics. Dr. Perez-Giraldo has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG therapeutics.

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