Surgery and amyotrophic lateral sclerosis: avoid the surgeon

'Surgery in ALS-don't rush in, always give it a second thought '

Pinto et al 1 document that amyotrophic lateral sclerosis (ALS) patients who have surgery <3 months after clinical onset of ALS are at risk of a more rapid progression of their disease. There is also a correlation between the site of ALS onset and surgical anatomy. Functional decline was greater when surgery was performed after ALS onset, possibly because of uncertain ALS diagnosis in this group.

Although anaesthesia and anaesthetic medications required for surgery are of concern in ALS, it is the accompanying physical trauma of surgery that is probably more relevant. Those familiar with ALS are anecdotally concerned that surgery, especially spinal surgery, not infrequently results in accelerated progression of ALS. The present study is welcome in formally confirming this concern. Spinal surgery may be a particular risk....