TNF and ischemia: White cord syndrome (WCS), or spinal cord ischemia–reperfusion injury, occurs when sudden reperfusion post-decompression triggers oxygen-free radical overproduction and inflammatory cytokine surge (TNF-α, IL-1β), disrupting the blood–spinal cord barrier.[17] The incidence and severity of WCS are closely related to the duration of ischemia, the extent of ischemic tissue, and the oxygen demand of the affected tissue.