White Cord Syndrome as a Rare Complication Post Cervical Spinal Decompression Surgery: A Case Report

White cord syndrome (WCS) is a rare complication following spinal decompression surgery, characterized by acute neurological deterioration and T2 hyperintensity on MRI. This is a case of a 60-year-old female with cervical myelopathy and significant cord compression who developed WCS after anterior cervical decompression and fusion (ACDF) at C5/6 and C6/7. Preoperatively, she presented with gait disturbances, dexterity issues, and left-sided weakness, progressively worsening over two years. Postoperatively, she experienced significant deterioration, with new motor deficits on the right upper limb and urinary retention. Despite initial improvements, she developed bowel incontinence and a complete loss of power in her left leg three weeks post surgery. Magnetic resonance imaging (MRI) excluded recurrent cord compression but showed progressive myelomalacia. Diagnosed with WCS, she was treated with high-dose dexamethasone, resulting in gradual neurological improvement.  White cord syndrome should be a main differential diagnosis in patients with unexplained neurological deterioration following cervical spinal decompression surgery, especially those with chronic cord compression. Further research is needed to better understand the pathophysiology and risk factors of WCS to improve outcomes.