脊髓再灌注损伤——小儿白索综合征罕见病例

Geethanjali Sundaram, R. Balasubramanian, Navya Christopher, S. Varadharajan, Seetharaman Cannane
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摘要

背景:脊柱减压术后神经功能缺损通常是由于血肿扩大或其他医源性损伤引起的。当一个明确的病因不能确定,它可能很少与再灌注损伤。这种无法解释的神经功能缺陷通常与影像学上脐带信号改变有关。它被认为是由缺血再灌注损伤引起的,由于其影像学表现,常被称为“白索综合征”。这种诊断是在排除其他差异后做出的。根据目前的文献,结果是可变的。我们报告一例颈鼻骨软骨瘤减压切除后可能出现白索综合征的患者。病例描述:在本病例报告中,我们报告了一位因缓慢进行性截瘫入院的年轻患者,初步影像学显示为C7-D1带脚骨软骨瘤。他接受了平稳的脊髓板切除术并切除了肿瘤。术后即刻,患者截瘫,并随访磁共振成像。在C7-D1水平肿块病变压迫区脊髓再次扩张,间隔异常T2/IR高强度从C6延伸至D1水平。结论:白索综合征是一种极为罕见的疾病。它被认为是由于压迫引起的脊髓慢性缺血区域再灌注损伤引起的。我们描述了一个在骨软骨瘤减压和切除后出现白索综合征的儿童。
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Reperfusion Injury in the Cord—Rare Case of Pediatric White Cord Syndrome
Background: Postoperative neurological deficits following spinal decompression are often caused due to an expanding hematoma or other iatrogenic injuries. When a definitive etiology could not be identified, it may rarely be related to a reperfusion injury. Such unexplained neurological deficits are often associated with the presence of cord signal changes on imaging. It is assumed to result from ischemia-reperfusion injury and is often designated as “white cord syndrome” due to its imaging appearance. Such a diagnosis is made after excluding other differentials. Outcomes are variable based on the current literature. We report a patient with possible white cord syndrome following decompression and excision of cervicodorsal osteochondroma. Case Description: In this case report, we present a young patient who was admitted with slowly progressive paraplegia, and initial imaging showed C7-D1 pedunculated osteochondroma. He underwent an uneventful spinal laminectomy accompanied by tumor excision. In the immediate postoperative period, the patient became paraplegic and a follow-up magnetic resonance imaging was taken. It showed re-expansion of cord in the region of compression by the mass lesion at C7-D1 level with interval abnormal T2/IR hyper intensity extending from C6 to D1 levels. Conclusion: White cord syndrome is an extremely rare condition. It is postulated to be caused by reperfusion injury to the cord within areas of chronic ischemia due to compressive causes. We describe a child with white cord syndrome following decompression and excision of an osteochondroma.
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