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

Orthop Traumatol Surg Res. 2015 Sep;101(5):637-41. doi: 10.1016/j.otsr.2015.06.001. Epub 2015 Jul 17.


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.

Keywords: Cervical spine prosthesis; Conversion motor disorder; Conversion paralysis; Hysterical paralysis; MRI artefacts.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Arthroplasty*
  • Cervical Vertebrae / surgery*
  • Conversion Disorder / psychology*
  • Female
  • Humans
  • Intervertebral Disc Displacement / surgery
  • Middle Aged
  • Paralysis / psychology*
  • Postoperative Complications*
  • Stress, Psychological / complications