Development of Acute Inflammatory Demyelinating Polyneuropathy 11 Days after Spinal Surgery: A Case Report and Literature Review

Abstract

Guillain–Barré syndrome (GBS) usually has a good prognosis; however, patients may develop sequelae without prompt treatment. We herein describe an 81-year-old woman who developed acute-onset excruciating thigh pain and weakness in her lower extremities after spinal surgery. We diagnosed acute inflammatory demyelinating polyradiculoneuropathy by a nerve conduction study, which showed findings of demyelination without cerebrospinal fluid analysis because of a spinal prosthesis. Although anti-GM1 and anti-GalNAc-GD1a antibodies were positive, the patient was clinically diagnosed with acute inflammatory demyelinating polyradiculoneuropathy (a subtype of GBS), not acute motor axonal neuropathy. She recovered well with immunoglobulin therapy. A literature review of 18 cases revealed that unexplained weakness, areflexia, and numbness of the extremities after spinal surgery, a shorter time from spinal surgery to symptom onset to general GBS, abnormal nerve conduction study results, normal spinal imaging findings, and the development of atypical symptoms such as cranial and autonomic nerve syndrome and respiratory failure are useful for diagnosing GBS when cerebrospinal fluid examination cannot be performed after spinal surgery.

Guillain-Barré Syndrome Following Lung Adenocarcinoma Surgery: A Case Report and Literature Review

“…Timely recognition of neurological symptoms, coupled with neurophysiological evaluations and CSF analysis, is imperative for accurate diagnosis [8]. A literature review of 18 cases conducted by Kakehi et al revealed that unexplained atypical symptomps and abnormal NCS findings are useful for diagnosing GBS when CSF examination cannot be performed after spinal surgery [5]. In our case, NCS demonstrated a multifocal demyelinating process and CSF exhibited elevated protein levels.…”

“…The administration of general or locoregional anesthesia preceding surgery may influence the natural course of GBS [4]. Notably, certain surgeries, particularly cardiothoracic, spine, and abdominal surgeries, have been associated with AIDP development [5][6][7]. Surgery may weaken the immune system, increasing susceptibility to infections and potentially triggering GBS through mechanisms such as autoimmunity or molecular mimicry [2,8].…”