Zain Boghani1, Andrew D Livingston1, Ericka P Simpson2, Paul J Holman1, Robert G Grossman3. 1. Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA. 2. Department of Neurology, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA. 3. Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA. Electronic address: rgrossman@houstonmethodist.org.
Abstract
BACKGROUND: Guillain-Barré syndrome (GBS) is an acute peripheral neuropathy caused by an autoimmune response against myelin of peripheral nerves. GBS has been reported after surgery, in general, and after spinal surgery, in particular. In most cases, GBS developed 1-3 weeks after surgery. METHODS: Report of 2 cases of GBS after elective spine surgery that developed in the immediate postoperative period. RESULTS: Within 1 and 3 hours after surgery, respectively, both patients developed ascending loss of motor and sensory function. They were taken back urgently to the operating room for wound exploration to ensure that an epidural hematoma had not developed. Cerebrospinal fluid studies and electromyography/nerve conduction velocity were then rapidly obtained and were compatible with acute inflammatory demyelinating polyradiculoneuropathy. Therapy was initiated with administration of intravenous immunoglobulin and plasmapheresis. Both patients made substantial motor recovery during the course of 1-2 years but have residual sensory abnormalities. CONCLUSIONS: GBS developing acutely after spinal surgery is a rare occurrence but should be considered in the differential diagnosis of neurological deterioration after surgery. Rapid diagnosis and treatment are essential for recovery of neurological function.
BACKGROUND: Guillain-Barré syndrome (GBS) is an acute peripheral neuropathy caused by an autoimmune response against myelin of peripheral nerves. GBS has been reported after surgery, in general, and after spinal surgery, in particular. In most cases, GBS developed 1-3 weeks after surgery. METHODS: Report of 2 cases of GBS after elective spine surgery that developed in the immediate postoperative period. RESULTS: Within 1 and 3 hours after surgery, respectively, both patients developed ascending loss of motor and sensory function. They were taken back urgently to the operating room for wound exploration to ensure that an epidural hematoma had not developed. Cerebrospinal fluid studies and electromyography/nerve conduction velocity were then rapidly obtained and were compatible with acute inflammatory demyelinating polyradiculoneuropathy. Therapy was initiated with administration of intravenous immunoglobulin and plasmapheresis. Both patients made substantial motor recovery during the course of 1-2 years but have residual sensory abnormalities. CONCLUSIONS: GBS developing acutely after spinal surgery is a rare occurrence but should be considered in the differential diagnosis of neurological deterioration after surgery. Rapid diagnosis and treatment are essential for recovery of neurological function.