Conversion paralysis after surgery for lumbar disc herniation.

Abstract

New neurologic deficit after spinal surgery is a rare complication that must be promptly diagnosed and treated to reduce the risk of permanent neurologic disability. A 37-year-old woman underwent left laminotomy and L5-S1 diskectomy for the treatment of L5-S1 disc herniation. She was found to be normal after recovery from anesthesia but loss of muscle power in the left lower limb after 1 h. Surgical exploration was performed; no obvious hemorrhage or compression because of hematoma was observed. After the exploration, the muscle power recovered but deteriorated after 10 h. Re-exploration did not yield any specific findings. In view of the normal electrophysiological and anatomic findings, a psychiatric evaluation confirmed the diagnosis of conversion paralysis with major depression disorder. Normal somatosensory-evoked potentials or motor-evoked potentials in a patient denying sensation of stimuli offer objective evidence of the psychogenic nature of the para/tetraplegia. This report describes a case in which psychopathology interfered with the outcome of a frequently used procedure for a well-defined, chronic, painful condition.