title: Acute Onset of Guillain-Barré Syndrome After Elective Spinal Surgery.
abstract: BACKGROUND
  Guillain-Barré syndrome (GBS) is an acute peripheral neuropathy caused by an autoimmune response against myelin of peripheral nerves. GBS has been reported after surgery, in general, and after spinal surgery, in particular. In most cases, GBS developed 1-3 weeks after surgery.
  
  
  METHODS
  Report of 2 cases of GBS after elective spine surgery that developed in the immediate postoperative period.
  
  
  RESULTS
  Within 1 and 3 hours after surgery, respectively, both patients developed ascending loss of motor and sensory function. They were taken back urgently to the operating room for wound exploration to ensure that an epidural hematoma had not developed. Cerebrospinal fluid studies and electromyography/nerve conduction velocity were then rapidly obtained and were compatible with acute inflammatory demyelinating polyradiculoneuropathy. Therapy was initiated with administration of intravenous immunoglobulin and plasmapheresis. Both patients made substantial motor recovery during the course of 1-2 years but have residual sensory abnormalities.
  
  
  CONCLUSIONS
  GBS developing acutely after spinal surgery is a rare occurrence but should be considered in the differential diagnosis of neurological deterioration after surgery. Rapid diagnosis and treatment are essential for recovery of neurological function.
authors.affiliation: Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA.
authors.forename: Zain
authors.initials: Z
authors.lastname: Boghani
authors.affiliation: Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Livingston
authors.affiliation: Department of Neurology, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA.
authors.forename: Ericka P
authors.initials: EP
authors.lastname: Simpson
authors.affiliation: Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Holman
authors.affiliation: Department of Neurosurgery, Houston Methodist Hospital Neurological Institute, Houston, Texas, USA. Electronic address: rgrossman@houstonmethodist.org.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Grossman
mesh_terms: D017558:Elective Surgical Procedures / Q000009:adverse effects; D059526:Foraminotomy / Q000009:adverse effects*; D020275:Guillain-Barre Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D013117:Spinal Cord Compression / Q000209:etiology / Q000601:surgery; D013122:Spinal Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013997:Time Factors
keywords: Acute inflammatory demyelinating polyradiculoneuropathy; Acute motor axonal neuropathy; Complications; Guillain-Barré syndrome; Spinal surgery