Case Reports in Medicine

Case Report

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

Table 2

Characteristics of previous patients diagnosed with Guillain–Barré syndrome after spinal surgery.
No.AuthorsAge/sexSpinal surgeryPostoperative onset timeDiagnostic delayMotor weakness at the nadirSensory deficits at the nadirTendon reflexPain
1Stambough et al. [11]33/FArthrodesis (T5–L2)20 days4 daysBilateral lower limbsPerioral and distal lower limbsAreflexiaNR
2Riebel et al. [12]62/FArthrodesis (T11–S)22 days3 daysBilateral upper and lower limbs (distal > proximal)Bilateral upper and lower limbs (distal > proximal)AreflexiaNR
3Cheng et al. [13]59/FLaminoplasty (T1–3), tumor resection6 hours8 daysBilateral upper and lower limbs (distal > proximal)Bilateral upper and lower limbsAreflexiaNR
4Son et al. [14]50/MSpinal canal decompression fusion (T10–L2)8 days2 daysBilateral upper and lower limbsBilateral handsAreflexiaNR
5Miscusi et al. [15]55/MLaminoplasty (C6/7)36 hoursNRBilateral lower limbsBelow the level of T5AreflexiaNR
6Battaglia et al. [16]73/FKyphoplasty (L1)7 daysNRBilateral upper and lower limbsBilateral lower limbsAreflexiaNR
7Boghani et al. [17]58/MLaminoplasty (L4/5)3 hours2 daysBilateral upper and lower limbsAscended to upper thighs, then to the abdomen, thorax, and armsHyporeflexiaYes
8—40/MLaminoplasty (L3/4)1 hourNRBilateral lower limbsBilateral lower limbsNRNR
9Huang et al. [18]50/MOccipitocervical fusion (occiput–C2), anterior cervical discectomy and fusion (C5/6)7 days16 daysBilateral upper and lower limbsNRNRNR
10—53/MLaminoplasty (C3–6)3 days19 daysBilateral lower limbsNRNRNR
11—69/MInstrumented posterior approach, lumbar interbody fusion (T10–L5)2 days12 daysBilateral upper and lower limbsNRNRNR
12—58/MAnterior cervical discectomy and fusion (C4–7)3 days4 daysBilateral lower limbsNRNRNR
13Chen et al. [19]57/MSpinal fusion (L3–S1)5 days6 daysBilateral lower limbsBelow the level of T3NRNR
14Rashid et al. [20]62/FSpinal fusion (L2–4)10 days2 daysBilateral lower limbsBilateral lower limbsAreflexiaNR
15Sahai et al. [21]52/MLaminectomy (L4/5)17 days2 daysBilateral lower limbs and left armNRAreflexiaNR
16Dowling and Dowling [22]53/FLaminectomy (L1/2)17 days7 daysBilateral lower limbsBilateral lower limbsAreflexiaYes
17Sanpei et al. [23]70/FCorrective surgery (L2/3)5 days14 daysBilateral lower limbsBilateral lower limbs (distal > proximal)AreflexiaNR
18Xu et al. [24]70/MSpinal fusion (L4/5)2 daysNRBilateral lower limbsBilateral lower limbs (distal > proximal)NormalYes
——Average 56.8Lumbar spine8 (44.4%)AverageAverageLower limbs only10 (55.6%)Lower limbs only7 (38.9%)11 (61.1%)3 (16.7%)
——M/F ratio 11 : 7Cervical spine4 (22.2%)7.4 days7.2 daysUpper and lower limbs8 (44.4%)Upper and lower limbs5 (27.8%)——
———Thoracolumbar3 (16.7%)——Upper limbs only0 (0.0%)Upper limbs only1 (11.1%)——
———Thoracic spine1 (5.6%)————NR5 (27.8%)——
———Thoracosacral1 (5.6%)————————
———Lumbosacral1 (5.6%)————————
19Present case81/FLaminectomy (L1–5), posterolateral fusion (L4/5)11 days9 daysBilateral lower limbsBilateral lower limbsAreflexiaYes
No.Autonomic nerve dysfunctionVentilator supportReoperation for explorationCSF†NCSAntiganglioside antibodyTreatmentFollow-up (months)Prognosis
1NoYesNoMissingAIDPNoHigh dose DEX24Neurologic deficits were improved.
2NoNoNoYesAIDPNoHigh dose corticosteroid, IVIg, PE6The neurological deficits, except for minor weakness of the intrinsic muscles of the hands, had completely resolved.
3Fever, tachycardia, diarrheaYesNoYesAMSANNoIVIg7Was able to transfer from bed to chair.
4Abdominal painYesYesMissingAIDPNoIVIg2The neurological deficits, except for minor weakness of the intrinsic muscles of the hands, had completely resolved.
5Fever, diarrheaNoYesYesAMSANGM1IVIg, mesalazine, meropenem3Progressive proximal-distal recovery of strength in both legs.
6NoNoNoYesAIDPNoIVIg4Left peripheral facial palsy.
7NoYesYesYesAIDPNoIVIg, PE12Paresthesia in lower trunk and legs.
8NoNoYesYesAIDPGM1IVIg, PE18Residual numbness of legs.
9NoYesYesMissingMissingNoIVIg22Was able to walk with a cane.
10NoYesNo3053/8AIDPNoIVIg22Was able to transfer from bed to chair.
11NoYesNoMissingAIDPNoIVIg11Ventilator support was required.
12NoNoNo500/5AIDPNoIVIg7Minor weakness of the intrinsic muscles of the hands.
13Atrial fibrillation, urinary retention, constipationYesNoMissingAIDPNoIVIg16Left diaphragm weakness.
14NoYesNoMissingAIDPNoIVIg12Was able to ambulate independently.
15NoNoYesYesMissingNoIVIg6Was able to ambulate without significant intervention.
16NoNoYesMissingAMSANNoIVIg2.5Nearly recovered.
17Hypertension, constipationNoNo1216/6AIDPNoIVIg, mPSLNRWas able to move her facial muscles and, gradually, her limbs.
18NoNoNoMissingAIDPNoIVIg1Regained 5/5 strength in extremities and could ambulate without aid.
—DysphagiaDigestive symptom5 (27.8%)9 (50.0%)7 (38.9%)10 (55.6%)Total16 (88.9%)2 (11.1%)IVIg17 (94.4%)—Improved17 (94.4%)
—Facial palsyFever2 (11.1%)———AIDP13 (72.2%)—PE3 (16.7%)—Not improved1 (5.6%)
—PtosisArrhythmia2 (11.1%)———AMSAN3 (16.7%)—IVIg + PE3 (16.7%)———
——Urinary retention1 (5.6%)——————Steroid3 (16.7%)———
19DiarrheaNoNoMissingAIDPGM1, GalNAc-GD1aIVIg1Was able to ambulate with a cane.
F, female; M, male; NR, not reported; CSF, cerebrospinal fluid; NCS, nerve conduction study; AMSAN, acute motor and sensory axonal neuropathy; AIDP, acute inflammatory demyelinating polyneuropathy; DEX, dexamethasone; IVIg, intravenous immunoglobulin; PE, plasma exchange; mPSL, methylprednisolone. †If albuminocytologic dissociation was present, it is shown as protein (mg/L)/white blood cell count.