White Cord Syndrome: Myelopathy Caused by an Ossified Posterior Longitudinal Ligament After Posterior Cervical Laminectomy and Fusion.

White cord syndrome (WCS) is a rare but serious postoperative complication after spinal decompression surgery. Risk factors such as advanced age, ossification of the posterior longitudinal ligament (OPLL), and major surgery may have predisposed this patient to develop WCS. This report discusses a 72-year-old Hispanic male patient with cervical stenosis due to OPLL who underwent posterior cervical decompression and fusion. After laminectomy and decompression were done, neuromonitoring signals decreased significantly. Despite intraoperative interventions after neuromonitoring signals decreased (e.g., mean arterial pressure augmentation with vasopressors, intravenous steroid therapy), the patient experienced significant quadriparesis following surgery. On postoperative imaging, spinal cord edema and T2 hyperintensities were noted on cervical MRI, consistent with the descriptions of WCS. The patient's postoperative course was marked by significant complications such as respiratory distress, hemodynamic instability, and infection, which ultimately led to his demise. This case highlights the necessity of individual risk factor stratification prior to surgery, careful neuromonitoring, and prompt treatment to manage suspected WCS.