Conversion paralysis after cervical spine arthroplasty: A case report and literature review

Abstract

We report a case of conversion paralysis after cervical spine arthroplasty performed in a 45-year-old woman to treat cervico-brachial neuralgia due to a left-sided C6-C7 disc herniation. Upon awakening from the anaesthesia, she had left hemiplegia sparing the face, with normal sensory function. Magnetic resonance imaging (MRI) of the brain ruled out a stroke. MRI of the spinal cord showed artefacts from the cobalt-chrome prosthesis that precluded confident elimination of mechanical spinal cord compression. Surgery performed on the same day to substitute a cage for the prosthesis ruled out spinal cord compression, while eliminating the source of MRI artefacts. Findings were normal from follow-up MRI scans 1 and 15days later, as well as from neurophysiological testing (electromyogram and motor evoked potentials). The deficit resolved fully within the next 4days. A psychological assessment revealed emotional distress related to an ongoing divorce. The most likely diagnosis was conversion paralysis. Surgeons should be aware that conversion disorder might develop after a procedure on the spine, although the risk of litigation requires re-operation. Familiarity with specific MRI sequences that minimise artefacts can be valuable. A preoperative psychological assessment might improve the detection of patients at high risk for conversion disorder.

Conversion Paralysis After Cervical Surgery: A Case Report and Literature Review

“…It is always induced by some traumatic event; the prevalence of patients admitted to spinal wards with conversion disorder was 0.3-3.8% (1)(2)(3)(12)(13)(14). Although it is rare, conversion disorders after spinal trauma or spinal surgery have been reported occasionally (1,7,15,16).…”

Post-operative functional neurological symptom disorder after anesthesia

“…In another 22-year old otherwise healthy patient with post-operative conversion paralysis of his left-sided extremities, stroke protocol and treatment were initiated for suspicion of brain infarction [ 32 ]. Two patients were also exposed to unanticipated invasive spine surgery as a result of their conversion paralysis mimicking spinal cord pathology: a 37-year old male status-post left laminotomy and L5-S1 diskectomy who experienced conversion paralysis with left-sided lower extremity weakness and subsequently underwent re-exploration of the L5-S1 disc space [ 18 ], and a 45-year old female status-post C6-C7 arthroplasty who experienced conversion paralysis with complete left-sided hemiplegia only sparing the face and subsequently underwent re-exploration of the C6-C7 disc space [ 30 ].…”

Psychogenic Hemiplegia after Cervical Spine Discectomies and Fusion

“…Psychogenic paralysis after minor trauma presents a difficult medico legal issue. Despite normal films and physical examination, the physician is forced to perform myelography to exclude lesions such as disk herniation, epidural hematoma, or contusion of the spinal cord [11,15]. It is the absence of expected findings that suggests and supports the diagnosis of Conversion Disorder.…”

“…The expected objective signs such as reflex changes following paralysis are rarely present. Conversion paralysis after cervical disc decompression and fusion is exceedingly rare occasion but reported in the literature [15]. The differential diagnosis of conversion disorder requires exclusion of other neurological disease, including strokes, multiple sclerosis, and epilepsy [1,2].…”