Acute motor-sensory axonal neuropathy after cervical spine surgery

Case report

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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.

Abbreviations used in this paper:AMSAN = acute motor-sensory axonal neuropathy; EMG = electromyography; ENG = electroneurography; GBS = Guillain-Barré syndrome.

Article Information

Address correspondence to: Massimo Miscusi, M.D., Ph.D., Department of Medico-Surgical Sciences and Biotechnologies, Section of Neurosurgery, Sapienza University of Rome, Corso della Repubblica 79, Latina 04100, Italy. email: m.miscusi@libero.it.

Please include this information when citing this paper: published online May 4, 2012; DOI: 10.3171/2012.4.SPINE11932.

© AANS, except where prohibited by US copyright law.

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Figures

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    a: Preoperative sagittal MRI study showing the lesion at C6–7 compressing and dislocating the spinal cord. b: Postoperative sagittal MRI study showing the complete removal of the lesion via a posterior approach. c: Intraoperative photograph; the dural sac has been opened posteriorly and anteriorly and, after the removal of the lesion, the spinal cord remains partially dislocated. d: Postoperative CT scan showing the absence of hemorrhagic complications and the correct positioning of the laminoplasty.

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    a: Photomicrograph of a section of large bowel mucosa showing coliform bacteria on glandular epithelium and an intense chronic inflammatory infiltrate with a few neutrophil granulocytes in the lamina propria. H & E, original magnification × 50. b: Photomicrograph showing a crypt abscess. H & E, original magnification × 400. c: Photomicrograph showing a section of large bowel mucosa in which all bacteria are stained blue. Giemsa, original magnification × 200. d: Photomicrograph showing coliform bacteria on the surface of glandular epithelium. Giemsa, original magnification × 400. e: Photomicrograph showing H. pylori. Immunohistochemistry with polyclonal antibody against H. pylori, original magnification × 50. f: Photomicrograph showing H. pylori on the epithelium as brown coliform structures. Immunohistochemistry with polyclonal antibody against H. pylori, original magnification × 400.

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