Conversion paralysis after surgery for lumbar disc herniation.
OBJECTIVE
New neurologic deficit after spinal surgery is a rare complication that must be promptly diagnosed and treated to reduce the risk of permanent neurologic disability.


BACKGROUND
A 37-year-old woman underwent left laminotomy and L5-S1 diskectomy for the treatment of L5-S1 disc herniation. She was found to be normal after recovery from anesthesia but loss of muscle power in the left lower limb after 1 h.


METHODS
Surgical exploration was performed; no obvious hemorrhage or compression because of hematoma was observed. After the exploration, the muscle power recovered but deteriorated after 10 h.


RESULTS
Re-exploration did not yield any specific findings. In view of the normal electrophysiological and anatomic findings, a psychiatric evaluation confirmed the diagnosis of conversion paralysis with major depression disorder.


CONCLUSIONS
Normal somatosensory-evoked potentials or motor-evoked potentials in a patient denying sensation of stimuli offer objective evidence of the psychogenic nature of the para/tetraplegia. This report describes a case in which psychopathology interfered with the outcome of a frequently used procedure for a well-defined, chronic, painful condition.
Hsieh
Ming-Kai
MK
Department of Orthopaedic Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Chang
Chen-Nen
CN
Hsiao
Mei-Chun
MC
Chen
Wen-Jer
WJ
Chen
Lih-Huei
LH
D000328:Adult; D003291:Conversion Disorder / Q000209:etiology / Q000523:psychology*; D003865:Major Depressive Disorder / Q000150:complications; D003937:Diagnosis, Differential; D003951:Diagnostic Errors / Q000517:prevention & control; D017586:Diskectomy / Q000009:adverse effects* / Q000523:psychology*; D004568:Electrodiagnosis / Q000379:methods; D019054:Evoked Potentials, Motor / Q000502:physiology; D005073:Evoked Potentials, Somatosensory / Q000502:physiology; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D009431:Neural Conduction / Q000502:physiology; D010243:Paralysis / Q000209:etiology / Q000523:psychology*; D011128:Polyradiculopathy / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000523:psychology*; D011859:Radiography; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D013126:Spinal Nerve Roots / Q000503:physiopathology; D055009:Spondylosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery