Tariq Hendawi1, Joseph M Zavatsky. 1. *Department of Orthopaedic Surgery, Ochsner Clinic Foundation, Back and Spine Center, New Orleans, LA and †Spine, Scoliosis & Deformity Institute, Florida Orthopaedic Institute, Tampa, FL.
Abstract
STUDY DESIGN: Case report. OBJECTIVE: To describe the important epidemiology, clinical presentation, and pathophysiology of Guillain-Barré syndrome (GBS) after orthopedic surgery in a trauma patient. SUMMARY OF BACKGROUND DATA: Little in the orthopedic literature describes trauma as an etiology of GBS. We report a case of post-traumatic GBS in a 52-year-old male who developed ascending weakness after experiencing pelvic trauma that required 2 separate orthopedic procedures for pelvic stabilization after a fall from a height of 12 ft. After the index operative procedure, the patient complained of left S1 numbness. Computed tomographic scan demonstrated the pelvic screw approximating the left S1 neuroforamen and correlated with the patient's immediate postoperative symptoms. A secondary procedure to reposition the screw alleviated the patient's left S1 numbness. Two weeks postoperatively, the patient developed profound ascending lower extremity weakness. This case highlights the importance of considering all etiologies, no matter how uncommon, in the differential diagnosis of lower extremity weakness. METHODS: Case report with literature search on GBS in orthopedic trauma patient. RESULTS: We propose that direct neural trauma from poorly positioned hardware resulting in clinical neurological symptoms may have been the inciting event that caused GBS in this trauma patient. CONCLUSION: Post-traumatic GBS is a rare, potentially life-threatening cause of weakness. Once mechanical causes are ruled out with appropriate imaging, all etiologies in the differential diagnosis must be explored. If the image findings cannot explain the clinical examination, other biologic causes of weakness, including GBS, must be explored. The causes of GBS in the postoperative trauma patient include infection, trauma, surgery, or direct neural injury. LEVEL OF EVIDENCE: 4.
STUDY DESIGN: Case report. OBJECTIVE: To describe the important epidemiology, clinical presentation, and pathophysiology of Guillain-Barré syndrome (GBS) after orthopedic surgery in a traumapatient. SUMMARY OF BACKGROUND DATA: Little in the orthopedic literature describes trauma as an etiology of GBS. We report a case of post-traumatic GBS in a 52-year-old male who developed ascending weakness after experiencing pelvic trauma that required 2 separate orthopedic procedures for pelvic stabilization after a fall from a height of 12 ft. After the index operative procedure, the patient complained of left S1 numbness. Computed tomographic scan demonstrated the pelvic screw approximating the left S1 neuroforamen and correlated with the patient's immediate postoperative symptoms. A secondary procedure to reposition the screw alleviated the patient's left S1 numbness. Two weeks postoperatively, the patient developed profound ascending lower extremity weakness. This case highlights the importance of considering all etiologies, no matter how uncommon, in the differential diagnosis of lower extremity weakness. METHODS: Case report with literature search on GBS in orthopedic traumapatient. RESULTS: We propose that direct neural trauma from poorly positioned hardware resulting in clinical neurological symptoms may have been the inciting event that caused GBS in this traumapatient. CONCLUSION: Post-traumatic GBS is a rare, potentially life-threatening cause of weakness. Once mechanical causes are ruled out with appropriate imaging, all etiologies in the differential diagnosis must be explored. If the image findings cannot explain the clinical examination, other biologic causes of weakness, including GBS, must be explored. The causes of GBS in the postoperative traumapatient include infection, trauma, surgery, or direct neural injury. LEVEL OF EVIDENCE: 4.