Navigating the Crisis of White Cord Syndrome in a Diabetic Female Patient After Cervical Spine Surgery: A Case Report

We report the case of a 72-year-old woman with a medical history of asthma, hypothyroidism, and type 2 diabetes mellitus who underwent C4-C6 corpectomy with fibular osseous graft replacement and C2-T1 decompressive laminectomy with C2-T1 lateral fusion. The procedure also included posterior spinal fixation from C2 to T1 using transpedicular screws, along with decompressive laminectomies at the C2-T1 levels for symptomatic multilevel cervical stenosis. Intraoperatively, the patient developed a sudden loss of all neuromonitoring signals, consistent with an acute neurological insult. High-dose corticosteroids were administered to reduce inflammation and edema, and blood pressure was aggressively managed with vasopressors to maintain adequate mean arterial pressure. Despite these interventions, the patient demonstrated postoperative neurological deterioration. The patients' motor strength improved in upper and lower extremities to 2/5 and 1/5, respectively, during evaluation in the postoperative care unit; however, neurological recovery plateaued during her subsequent stay in the neuro-intensive care unit, prompting transfer to an inpatient rehabilitation facility. In this case report, we present the intraoperative and postoperative management of an elderly diabetic patient who developed acute neurological deficits consistent with white cord syndrome (WCS) following cervical spine surgery, with particular emphasis on the interplay between perioperative hyperglycemia, high-dose corticosteroids, and WCS pathophysiology.