Paraplegia in the emergency room: spinal cord compression and Guillain-Barré syndrome-a 2025 scoping review from a multidisciplinary emergency perspective

Abstract

Acute paraplegia is a frequent and high-stake presentation in emergency departments. Spinal cord compression (SCC), particularly malignant epidural SCC, is a common oncologic emergency requiring urgent intervention, whereas Guillain-Barré syndrome (GBS) is a rarer but potentially life-threatening autoimmune polyradiculoneuropathy. Early differentiation between these conditions is essential, as delays in diagnosis and treatment are associated with irreversible neurological deficits and increased morbidity. Our objective is to synthesize recent evidence on the pathophysiology, clinical presentation, diagnosis, and management of SCC and GBS, with emphasis on early differentiation and multidisciplinary care strategies in emergency and rehabilitation settings. A scoping review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Electronic databases (PubMed, MEDLINE, Scopus, ScienceDirect, and CINAHL) were searched for English language studies published between January 2020 and June 2025. The review focused on clinical studies and reports addressing early differentiation and multidisciplinary management of SCC and GBS in emergency settings. Nineteen studies met the inclusion criteria. The review found that GBS diagnosis relies heavily on recognizing progressive symmetric weakness and preceding infectious triggers, while SCC requires immediate imaging and prompt corticosteroid administration. The limited number of studies highlights a gap in integrated emergency protocols for distinguishing these conditions. Surgical decompression remains the cornerstone of SCC management, with emerging evidence suggesting potential benefits even beyond the traditional 24-h window. This scoping review reinforces the critical need for early differentiation between SCC and GBS. Although the available literature is limited, it underscores the importance of coordinated multidisciplinary care. Clinicians must remain attentive to evolving diagnostic algorithms, particularly in light of new evidence supporting extended surgical windows for SCC.

Keywords

acute paraplegia / decompressive surgery / emergency medicine / Guillain-Barré syndrome / immunotherapy / multidisciplinary care / spinal cord compression

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