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腰椎翻修术后吉兰-巴雷综合征:一例报告

Guillain-Barré Syndrome After Revision Lumbar Surgery: A Case Report.

作者信息

Rashid Aymen, Kurra Swamy, Lavelle William

机构信息

Department of Orthopedic Surgery, SUNY Upstate Medical University.

出版信息

Cureus. 2017 Jun 26;9(6):e1393. doi: 10.7759/cureus.1393.

Abstract

Guillain-Barré syndrome (GBS) is a term that is used to describe a group of immune-mediated peripheral neuropathies, with the most common feature being rapid polyradiculoneuropathy. The exact etiology of this syndrome is unknown. In the field of orthopedics, GBS has been reported to occur after total hip arthroplasty, orthopedic trauma, and spine surgery. We report a unique case of GBS after elective revision lumbar spine surgery. A 62-year-old female presented with persistent low back pain and radiculopathy and elected to have revision lumbar spine surgery. Approximately 24 to 36 hours after hospital discharge, she returned to the hospital with weakness in her legs. After an electromyography (EMG), the patient was diagnosed with GBS and placed on intravenous immunoglobulin (IVIG). She developed respiratory failure, which required intubation and eventually converted to a tracheostomy and was finally decannulated. Over the course of 12 months, she improved to her pre-surgical baseline, gaining 5/5 strength in her upper and lower extremities and was able to ambulate independently without any aids. This was a case of GBS that occurred in a patient approximately two weeks after revision lumbar surgery. GBS is a poorly understood and rare complication of lumbar spine surgery that needs to be recognized quickly to be effectively treated.

摘要

吉兰-巴雷综合征(GBS)是一个用于描述一组免疫介导的周围神经病的术语,最常见的特征是快速进展性多神经根神经病。该综合征的确切病因尚不清楚。在骨科领域,已有报道GBS发生于全髋关节置换术、骨科创伤和脊柱手术后。我们报告了一例择期腰椎翻修手术后发生GBS的独特病例。一名62岁女性因持续性腰痛和神经根病就诊,并选择接受腰椎翻修手术。出院后约24至36小时,她因双腿无力返回医院。经肌电图(EMG)检查后,该患者被诊断为GBS,并接受了静脉注射免疫球蛋白(IVIG)治疗。她出现了呼吸衰竭,需要插管,最终改为气管造口术,最后拔管。在12个月的时间里,她恢复到了手术前的基线水平,上下肢肌力达到5/5,能够独立行走而无需任何辅助。这是一例腰椎翻修手术后约两周发生在患者身上的GBS病例。GBS是腰椎手术中一种了解较少且罕见的并发症,需要迅速识别以便有效治疗。

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