409 - The Surgical Enigma: Tracing Post-Surgical Guillain-Barré Syndrome

Case Diagnosis: Post Surgical Guillain-Barré Syndrome

Case Description: A 68-year-old woman with history of Parkinson's disease and hypertension presented with worsening back pain and lower extremity weakness, including adjacent-level disease from a prior lumbar surgery now requiring revision surgery. Following surgery, she experienced mobility improvement, undergoing tailored pain management and rehab. However, on the 12th day, she developed acute bilateral lower extremity numbness, leading to intubation and admission to the Neurosurgical Intensive Care Unit. An EMG/NCS on the 18th day generated a suspicion of Guillain-Barré syndrome, eventually treated with IVIg. Over time, her condition improved, and she was successfully extubated on the 38th day. She then transitioned to inpatient rehabilitation on the 44th day, marked by intermittent rigidity and numbness. On the 69th day, she was discharged with a comprehensive rehabilitation plan, highlighting interdisciplinary therapy and neurology follow-up.



Discussions: Guillain-Barré syndrome (GBS) encompasses a heterogeneous group of immune-mediated disorders that target the peripheral nervous system, resulting in a diverse clinical presentation. It has been recognized as a significant cause of acute flaccid paralysis worldwide, affecting 0.8 to 1.9 per 100,000 individuals annually [1]. Recent studies have unveiled the potential triggering role of surgery in GBS. A retrospective review found a 13.1 times higher relative risk of developing GBS in patients who had undergone surgery six weeks prior [2]. The complexities of managing this syndrome necessitate a multidisciplinary approach that revolves around recognizing the possibility and clinical presentation of GBS during the postoperative course.

Conclusions: This report aims to contribute to the existing literature by detailing a case of GBS following elective revision lumbar spine surgery, adding evidence that supports the potential triggering effect of surgical interventions while also contributing to the awareness of morbidity and mortality associated with GBS in the post-surgical setting.