title: Acute motor-sensory axonal neuropathy after cervical spine surgery.
abstract: The authors report the case of a 55-year-old man who presented with acute motor-sensory axonal neuropathy (AMSAN), a variant of Guillain-Barré syndrome with a poor prognosis, immediately after surgery for resection of a cervical chondroma. A misdiagnosis of spinal cord shock due to an acute surgical or vascular postoperative complication was initially made in this patient. Nevertheless, there was continuous transient improvement that was followed by progressive worsening, and further investigation was necessary. The diagnosis of AMSAN, associated with acute colitis caused by Helicobacter pylori, was made based on neurophysiological examinations and colonoscopy. Interestingly, the patient also developed nephrotic syndrome, which was thought to be a further complication of the autoimmune reaction. Delayed administration of immunoglobulins (400 mg/kg/day), mesalazine (800 mg 3×/day), and meropenem (3 g/day) was used to treat the Helicobacter infection and the autoimmune reaction, leading to restoration of renal function and slight neurological improvement. The patient's general condition and neurological status improved slightly, but he remained seriously disabled (Frankel Grade C). This case demonstrates that a new onset of neurological symptoms in the early postoperative period after spine surgery could be related to causes other than iatrogenic myelopathy, and that an early diagnosis can reduce neurological sequelae, leading to a better outcome.
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, Latina, Italy. m.miscusi@libero.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Miscusi
authors.forename: Antonio
authors.initials: A
authors.lastname: Currà
authors.forename: Carlo
authors.initials: C
authors.lastname: Della Rocca
authors.forename: Paolo
authors.initials: P
authors.lastname: Missori
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Petrozza
mesh_terms: D001323:Autoantibodies / Q000097:blood; D001327:Autoimmune Diseases / Q000175:diagnosis* / Q000276:immunology; D002574:Cervical Vertebrae / Q000601:surgery*; D002812:Chondroma / Q000601:surgery*; D003092:Colitis / Q000150:complications; D003113:Colonoscopy; D003951:Diagnostic Errors; D004185:Disability Evaluation; D018450:Disease Progression; D005500:Follow-Up Studies; D020275:Guillain-Barre Syndrome / Q000175:diagnosis* / Q000276:immunology; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis; D016480:Helicobacter pylori; D006801:Humans; D007049:Iatrogenic Disease; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000175:diagnosis; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis* / Q000601:surgery; D012086:Reoperation; D013117:Spinal Cord Compression / Q000601:surgery*; D013125:Spinal Neoplasms / Q000601:surgery*
chemical_list: D001323:Autoantibodies