Cervical spine surgery complicated by postoperative Guillain-Barré syndrome

Abstract

Guillain-Barré syndrome (GBS) is an idiopathic, immune-mediated attack of the peripheral nervous system, with patients most commonly presenting with bilateral, ascending weakness, and loss of deep tendon reflexes. Considered an extremely rare post-operative complication, particularly in cervical spine patients, we report a unique case of GBS following anterior cervical spine surgery. The patient is a 65-year-old male with no relevant prior medical or surgical history who presented with right arm weakness and stiffness. After decompression and fusion via an anterior approach, the patient was discharged two days later without incident. On post-operative day 8, the patient returned to the hospital with profound weakness in the bilateral lower extremities. Subsequent cerebrospinal fluid analysis and nerve conduction studies revealed albuminocytologic dissociation and axonal polyneuropathy, respectively. The patient was diagnosed with GBS and was promptly treated with intravenous immunoglobulin (IVIG). At 5-month follow-up, the patient returned to his pre-operative baseline and exhibited full strength in the lower extremities. GBS is an extremely rare post-operative complication of cervical spine surgery and needs to be identified quickly in patients presenting with post-operative sensorimotor changes to improve the natural history of the disease. Keywords: Cervical spine, Guillain-Barré syndrome