Chen Eric Yensen, Stratton Corinne, Mercer Brian, Hohler Anna, Tannoury Tony Y, Tannoury Chadi
From the Department of Orthopaedic Surgery (Dr. Chen, Ms. Stratton, Dr. Mercer, Dr. T. Tannoury, and Dr. C. Tannoury) and the Department of Neurology (Dr. Hohler), Boston Medical Center, Boston, MA.
J Am Acad Orthop Surg. 2017 Aug;25(8):587-593. doi: 10.5435/JAAOS-D-16-00572.
Guillain-Barré syndrome is a rare autoimmune condition characterized by ascending motor weakness of the extremities that can ascend to the diaphragm, causing substantial morbidity and mortality. This case report describes a 57-year-old man who exhibited characteristics of Guillain-Barré syndrome 9 days after undergoing lumbar fusion at L3-S1. The diagnosis was based on the patient's ascending motor weakness and areflexia and was confirmed with electromyography. The patient progressed to respiratory failure, requiring mechanical ventilation. He regained motor function and ambulation within 6 months. Although the syndrome typically manifests initially as ascending paralysis, this patient's initial symptom was new-onset atrial fibrillation, a sign of autonomic dysfunction. Because it can cause paralysis and respiratory failure, Guillain-Barré syndrome should be included in the differential diagnosis whenever motor weakness is observed after lumbar surgery. The timing of symptoms, imaging results, and the development of atypical symptoms can help distinguish this rare possibility from other postoperative spinal complications.
吉兰-巴雷综合征是一种罕见的自身免疫性疾病，其特征为四肢进行性运动无力，可向上发展至膈肌，导致较高的发病率和死亡率。本病例报告描述了一名57岁男性，他在L3-S1行腰椎融合术后9天出现了吉兰-巴雷综合征的特征。诊断基于患者的进行性运动无力和无反射，并通过肌电图得到证实。患者进展为呼吸衰竭，需要机械通气。他在6个月内恢复了运动功能并能行走。尽管该综合征通常最初表现为进行性麻痹，但该患者的初始症状是新发房颤，这是自主神经功能障碍的一个迹象。由于吉兰-巴雷综合征可导致麻痹和呼吸衰竭，因此每当腰椎手术后出现运动无力时，应将其纳入鉴别诊断。症状出现的时间、影像学结果以及非典型症状的发展有助于将这种罕见的可能性与其他术后脊柱并发症区分开来。
