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Reperfusion injury of spinal cord “white cord syndrome” refers to acute neurological deterioration after decompressive spinal surgery without any reported intraoperative events. The postoperative appearance of diffuse hyperintense intramedullary areas in T2-weighted MRI is characteristic without any other pathological or compressive signs. The etiology may be due to sudden expansion of the cord after reperfusion of chronically ischemic areas leading to disruption of blood-spinal cord barrier. The incidence and risk factors of the syndrome are not well documented in the literature.

This is a retrospective case series that included 150 patients with cervical spondylotic myelopathy who had undergone decompression surgery in our institution from 2017 to 2019. Patients’ demographics, clinical, imaging characteristics, intraoperative and postoperative data were collected and analysed.

In this study, we documented 7 cases of this syndrome. We found that advanced age, chronic hypertension, pre-existing cord signal in MRI and long history of symptoms may be risk factors for this syndrome.

Early diagnosis and prompt treatment of this syndrome with steroids and physical therapy may lead to initial improvement. Awareness of the surgeons about this syndrome should be increased and identifying its risk factors is very important for patients counseling.