Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2021; 9(5): 1096-1102
Published online Feb 16, 2021. doi: 10.12998/wjcc.v9.i5.1096
Severe lumbar spinal stenosis combined with Guillain-Barré syndrome: A case report
Dan-Feng Xu, Bing Wu, Jin-Xin Wang, Jian Yu, Jian-Xin Xie
Dan-Feng Xu, Bing Wu, Jin-Xin Wang, Jian Yu, Jian-Xin Xie, Department of Orthopedic Surgery, Shaoxing Central Hospital, Shaoxing 312000, Zhejiang Province, China
Author contributions: Xie JX and Yu J designed the report; Wu B and Wang JX collected the patient’s clinical data; Xu DF wrote the paper.
Supported by Keqiao Clinical Funding, No. 2019KZ19 and No. 2018KZ43.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to report.
CARE Checklist (2016) statement: The guidelines of the CARE Checklist (2016) have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Xin Xie, MD, PhD, Professor, Department of Orthopedic Surgery, Shaoxing Central Hospital, No. 1 Huayu Road, Keqiao, Shaoxing 312000, Zhejiang Province, China. xjxclyjw@163.com
Received: July 25, 2020
Peer-review started: July 25, 2020
First decision: November 26, 2020
Revised: December 10, 2020
Accepted: December 23, 2020
Article in press: December 23, 2020
Published online: February 16, 2021
Abstract
BACKGROUND

Guillain-Barré syndrome (GBS) is a rare disorder that typically presents with ascending weakness, pain, paraesthesias, and numbness, which mimic the findings in lumbar spinal stenosis. Here, we report a case of severe lumbar spinal stenosis combined with GBS.

CASE SUMMARY

A 70-year-old man with a history of lumbar spinal stenosis presented to our emergency department with severe lower back pain and lower extremity numbness. Magnetic resonance imaging confirmed the diagnosis of severe lumbar spinal stenosis. However, his symptoms did not improve postoperatively and he developed dysphagia and upper extremity numbness. An electromyogram was performed. Based on his symptoms, physical examination, and electromyogram, he was diagnosed with GBS. After 5 d of intravenous immunoglobulin (0.4 g/kg/d for 5 d) therapy, he gained 4/5 of strength in his upper and lower extremities and denied paraesthesias. He had regained 5/5 of strength in his extremities when he was discharged and had no symptoms during follow-up.

CONCLUSION

GBS should be considered in the differential diagnosis of spinal disorder, even though magnetic resonance imaging shows severe lumbar spinal stenosis. This case highlights the importance of a careful diagnosis when a patient has a history of a disease and comes to the hospital with the same or similar symptoms.

Keywords: Lumbar spinal stenosis, Guillain-Barré syndrome, Lower back pain, Paraesthesias, Diagnose, Case report

Core Tip: A 70-year-old man with a history of lumbar spinal stenosis presented to our emergency department because of severe lower back pain and lower extremity numbness. On the physical examination, he had 4/5 of strength in both legs and decreased sensation below the knees. Magnetic resonance imaging demonstrated lumbar spinal stenosis (L4/5). Based on these findings, he was diagnosed with lumbar spinal stenosis. After conservative treatment failed, he underwent transforaminal lumbar interbody fusion. However, his symptoms worsened postoperatively and dysphagia appeared. An electromyogram was performed. Finally, he was diagnosed with Guillain-Barré syndrome. After 5 d of intravenous immunoglobulin therapy, he gained 4/5 of strength in his upper and lower extremities and denied paraesthesias. This case demonstrates that Guillain-Barré syndrome should be considered in the differential diagnosis of spinal disorder and highlights the importance of a careful diagnosis when a patient has a history of a disease and comes to the hospital with the same or similar symptoms.