White cord syndrome following cervical spine surgery: A case report and systematic literature review

White cord syndrome (WCS) is a rare but severe post-operative complication following cervical spine decompression surgery, characterized by acute neurological deterioration and T2-weighted hyperintensity on magnetic resonance imaging (MRI), suggestive of ischemia-reperfusion injury. This study presents a case of WCS following anterior cervical discectomy and fusion (ACDF) and conducts a systematic review to analyze risk factors, management strategies, and outcomes associated with WCS. A systematic literature review was conducted according to preferred reporting items for systematic reviews and meta-analyses guidelines. PubMed, Embase, Scopus, and Cochrane Library were searched for studies reporting WCS following cervical decompression surgery. Inclusion criteria encompassed case reports and case series with documented post-operative neurological deficits and MRI-confirmed T2 hyperintensity. Data extraction included demographics, clinical presentation, treatment strategies, and neurological outcomes. In addition, we describe a case report of WCS following ACDF at C6–C7 with complete neurological recovery after corticosteroid therapy and intensive rehabilitation. A total of 30 articles, including 37 patients, were analyzed. ACDF and posterior cervical decompression and fusion were the most common procedures associated with WCS. Postoperatively, all patients developed acute neurological decline, with 25% achieving full recovery, 44% showing partial improvement, and 31% remaining permanently disabled. Steroid administration and early rehabilitation correlated with improved outcomes, whereas delayed intervention and pre-existing myelomalacia were associated with worse prognoses. WCS is an underrecognized but potentially devastating complication of cervical decompression surgery. Early recognition, aggressive treatment with corticosteroids, blood pressure optimization, and intensive rehabilitation may improve functional recovery. Standardized treatment protocols and multicenter prospective studies are needed to define preventive and therapeutic strategies for this condition