Table 2.
Characteristics of previous patients diagnosed with Guillain–Barré syndrome after spinal surgery.
| No. | Authors | Age/sex | Spinal surgery | Postoperative onset time | Diagnostic delay | Motor weakness at the nadir | Sensory deficits at the nadir | Tendon reflex | Pain | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | Stambough et al. [11] | 33/F | Arthrodesis (T5–L2) | 20 days | 4 days | Bilateral lower limbs | Perioral and distal lower limbs | Areflexia | NR | ||||||||||
| 2 | Riebel et al. [12] | 62/F | Arthrodesis (T11–S) | 22 days | 3 days | Bilateral upper and lower limbs (distal > proximal) | Bilateral upper and lower limbs (distal > proximal) | Areflexia | NR | ||||||||||
| 3 | Cheng et al. [13] | 59/F | Laminoplasty (T1–3), tumor resection | 6 hours | 8 days | Bilateral upper and lower limbs (distal > proximal) | Bilateral upper and lower limbs | Areflexia | NR | ||||||||||
| 4 | Son et al. [14] | 50/M | Spinal canal decompression fusion (T10–L2) | 8 days | 2 days | Bilateral upper and lower limbs | Bilateral hands | Areflexia | NR | ||||||||||
| 5 | Miscusi et al. [15] | 55/M | Laminoplasty (C6/7) | 36 hours | NR | Bilateral lower limbs | Below the level of T5 | Areflexia | NR | ||||||||||
| 6 | Battaglia et al. [16] | 73/F | Kyphoplasty (L1) | 7 days | NR | Bilateral upper and lower limbs | Bilateral lower limbs | Areflexia | NR | ||||||||||
| 7 | Boghani et al. [17] | 58/M | Laminoplasty (L4/5) | 3 hours | 2 days | Bilateral upper and lower limbs | Ascended to upper thighs, then to the abdomen, thorax, and arms | Hyporeflexia | Yes | ||||||||||
| 8 | — | 40/M | Laminoplasty (L3/4) | 1 hour | NR | Bilateral lower limbs | Bilateral lower limbs | NR | NR | ||||||||||
| 9 | Huang et al. [18] | 50/M | Occipitocervical fusion (occiput–C2), anterior cervical discectomy and fusion (C5/6) | 7 days | 16 days | Bilateral upper and lower limbs | NR | NR | NR | ||||||||||
| 10 | — | 53/M | Laminoplasty (C3–6) | 3 days | 19 days | Bilateral lower limbs | NR | NR | NR | ||||||||||
| 11 | — | 69/M | Instrumented posterior approach, lumbar interbody fusion (T10–L5) | 2 days | 12 days | Bilateral upper and lower limbs | NR | NR | NR | ||||||||||
| 12 | — | 58/M | Anterior cervical discectomy and fusion (C4–7) | 3 days | 4 days | Bilateral lower limbs | NR | NR | NR | ||||||||||
| 13 | Chen et al. [19] | 57/M | Spinal fusion (L3–S1) | 5 days | 6 days | Bilateral lower limbs | Below the level of T3 | NR | NR | ||||||||||
| 14 | Rashid et al. [20] | 62/F | Spinal fusion (L2–4) | 10 days | 2 days | Bilateral lower limbs | Bilateral lower limbs | Areflexia | NR | ||||||||||
| 15 | Sahai et al. [21] | 52/M | Laminectomy (L4/5) | 17 days | 2 days | Bilateral lower limbs and left arm | NR | Areflexia | NR | ||||||||||
| 16 | Dowling and Dowling [22] | 53/F | Laminectomy (L1/2) | 17 days | 7 days | Bilateral lower limbs | Bilateral lower limbs | Areflexia | Yes | ||||||||||
| 17 | Sanpei et al. [23] | 70/F | Corrective surgery (L2/3) | 5 days | 14 days | Bilateral lower limbs | Bilateral lower limbs (distal > proximal) | Areflexia | NR | ||||||||||
| 18 | Xu et al. [24] | 70/M | Spinal fusion (L4/5) | 2 days | NR | Bilateral lower limbs | Bilateral lower limbs (distal > proximal) | Normal | Yes | ||||||||||
| — | — | Average 56.8 | Lumbar spine | 8 (44.4%) | Average | Average | Lower limbs only | 10 (55.6%) | Lower limbs only | 7 (38.9%) | 11 (61.1%) | 3 (16.7%) | |||||||
| — | — | M/F ratio 11 : 7 | Cervical spine | 4 (22.2%) | 7.4 days | 7.2 days | Upper and lower limbs | 8 (44.4%) | Upper and lower limbs | 5 (27.8%) | — | — | |||||||
| — | — | — | Thoracolumbar | 3 (16.7%) | — | — | Upper limbs only | 0 (0.0%) | Upper limbs only | 1 (11.1%) | — | — | |||||||
| — | — | — | Thoracic spine | 1 (5.6%) | — | — | — | — | NR | 5 (27.8%) | — | — | |||||||
| — | — | — | Thoracosacral | 1 (5.6%) | — | — | — | — | — | — | — | — | |||||||
| — | — | — | Lumbosacral | 1 (5.6%) | — | — | — | — | — | — | — | — | |||||||
| 19 | Present case | 81/F | Laminectomy (L1–5), posterolateral fusion (L4/5) | 11 days | 9 days | Bilateral lower limbs | Bilateral lower limbs | Areflexia | Yes | ||||||||||
|
| |||||||||||||||||||
| No. | Autonomic nerve dysfunction | Ventilator support | Reoperation for exploration | CSF† | NCS | Antiganglioside antibody | Treatment | Follow-up (months) | Prognosis | ||||||||||
| 1 | No | Yes | No | Missing | AIDP | No | High dose DEX | 24 | Neurologic deficits were improved. | ||||||||||
| 2 | No | No | No | Yes | AIDP | No | High dose corticosteroid, IVIg, PE | 6 | The neurological deficits, except for minor weakness of the intrinsic muscles of the hands, had completely resolved. | ||||||||||
| 3 | Fever, tachycardia, diarrhea | Yes | No | Yes | AMSAN | No | IVIg | 7 | Was able to transfer from bed to chair. | ||||||||||
| 4 | Abdominal pain | Yes | Yes | Missing | AIDP | No | IVIg | 2 | The neurological deficits, except for minor weakness of the intrinsic muscles of the hands, had completely resolved. | ||||||||||
| 5 | Fever, diarrhea | No | Yes | Yes | AMSAN | GM1 | IVIg, mesalazine, meropenem | 3 | Progressive proximal-distal recovery of strength in both legs. | ||||||||||
| 6 | No | No | No | Yes | AIDP | No | IVIg | 4 | Left peripheral facial palsy. | ||||||||||
| 7 | No | Yes | Yes | Yes | AIDP | No | IVIg, PE | 12 | Paresthesia in lower trunk and legs. | ||||||||||
| 8 | No | No | Yes | Yes | AIDP | GM1 | IVIg, PE | 18 | Residual numbness of legs. | ||||||||||
| 9 | No | Yes | Yes | Missing | Missing | No | IVIg | 22 | Was able to walk with a cane. | ||||||||||
| 10 | No | Yes | No | 3053/8 | AIDP | No | IVIg | 22 | Was able to transfer from bed to chair. | ||||||||||
| 11 | No | Yes | No | Missing | AIDP | No | IVIg | 11 | Ventilator support was required. | ||||||||||
| 12 | No | No | No | 500/5 | AIDP | No | IVIg | 7 | Minor weakness of the intrinsic muscles of the hands. | ||||||||||
| 13 | Atrial fibrillation, urinary retention, constipation | Yes | No | Missing | AIDP | No | IVIg | 16 | Left diaphragm weakness. | ||||||||||
| 14 | No | Yes | No | Missing | AIDP | No | IVIg | 12 | Was able to ambulate independently. | ||||||||||
| 15 | No | No | Yes | Yes | Missing | No | IVIg | 6 | Was able to ambulate without significant intervention. | ||||||||||
| 16 | No | No | Yes | Missing | AMSAN | No | IVIg | 2.5 | Nearly recovered. | ||||||||||
| 17 | Hypertension, constipation | No | No | 1216/6 | AIDP | No | IVIg, mPSL | NR | Was able to move her facial muscles and, gradually, her limbs. | ||||||||||
| 18 | No | No | No | Missing | AIDP | No | IVIg | 1 | Regained 5/5 strength in extremities and could ambulate without aid. | ||||||||||
| — | Dysphagia | Digestive symptom | 5 (27.8%) | 9 (50.0%) | 7 (38.9%) | 10 (55.6%) | Total | 16 (88.9%) | 2 (11.1%) | IVIg | 17 (94.4%) | — | Improved | 17 (94.4%) | |||||
| — | Facial palsy | Fever | 2 (11.1%) | — | — | — | AIDP | 13 (72.2%) | — | PE | 3 (16.7%) | — | Not improved | 1 (5.6%) | |||||
| — | Ptosis | Arrhythmia | 2 (11.1%) | — | — | — | AMSAN | 3 (16.7%) | — | IVIg + PE | 3 (16.7%) | — | — | — | |||||
| — | — | Urinary retention | 1 (5.6%) | — | — | — | — | — | — | Steroid | 3 (16.7%) | — | — | — | |||||
| 19 | Diarrhea | No | No | Missing | AIDP | GM1, GalNAc-GD1a | IVIg | 1 | Was 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.