Having said that in that first case of hyperacute onset, neurological symptoms started almost immediately post op and peaked after two days. That would be quite the coincidence.

Maybe high dose corticosteroids?

A more plausible mechanism would be the inflammatory effects of surgery, rather than toxicity/triggering from a spinal. I feel like the spinal is an innocent bystander.

In this SR of case reports, the majority of surgeries are spine and cardiac.

pmc.ncbi.nlm.nih.gov/articles/PMC...

Fully agree

I think it is a coincidence. GBS can occur within 4 weeks of campylobacter infection. Preop diarrhoea can be common in some populations (eg bariatrics ~ nearly 10%), and it isn’t usually asked about.

Have any authors proposed a mechanism whereby a central drug exposure creates a peripheral neuropathy?

“Do not intubate in the “coffin position””. Quote Dr Richard Levitan

Agree

One could probably calculate the odds of it arising by chance using the prevalence of GBS in the general population and the odds of needing a spinal/epidural

Yes I wondered that too. Association is not causation

You could also write that case as “patient developed GBS one day after shopping at the supermarket. Is there causation? It can be coincidence?!

Interesting, the question remains if this also would have happened with GA. There probably is an activation of some kind of autoimmune response due to surgery or anaesthesia or stress? Are there hypothesis in the article?

Onset apparently almost immediate, peaking day two post spinal

jmedicalcasereports.biomedcentral.com/articles/10....

This article reported acute onset GBS in 4 patients within 1-2 weeks of epidural anaesthesia
www.neurology.org/doi/10.1212/...

This case report of a pt developing GBS 4-5 days post spinal for renal calculi. It's rare, but it happens. www.jcpsp.pk/archive/2013...

How much time between spinal and onset GBS symptoms?