Guillain-Barré syndrome following elective spine surgery

There is a paucity of literature describing Guillain-Barré syndrome (GBS) in the elective orthopedic patient. We aim to report one such case following spine surgery.

A morbidly obese 52-year-old male developed diminished reflexes as well as left upper and lower extremity weakness following surgical decompression and fusion at L4-5. The patient had persistent weakness and progressed to areflexia, at which point urgent lumbar puncture supported a diagnosis of GBS.

The patient was promptly started on intravenous immunoglobulin and made significant clinical improvement with near-complete resolution of symptoms by 3-month follow-up visit. By the sixth month, he was able to function and ambulate without a cane. GBS is a rare and potentially critical cause of diminished reflexes and weakness in the post-operative elective orthopedic patient. We propose that morbid obesity may have contributed to the patient's susceptibility of developing GBS following surgery.

Neurologic symptoms of this autoimmune condition may also mimic the clinical picture of an elective spine patient, thus confounding diagnosis. If imaging cannot explain exam findings or new neurologic symptoms post-operatively, rare disease processes should be considered in the differential diagnosis.