ABSTRACT
STUDY DESIGN: Short communication. OBJECTIVES: To report a case with bilateral lower extremity complex regional pain syndrome (CRPS) in a patient with paraplegia occurring following spinal disc herniation surgery, who was treated successfully with pulse radiofrequency (PRF) lumbar sympatholysis. SETTING: Departments of Physical Medicine and Rehabilitation, Algology Department of Anaesthesiology and Nuclear Medicine, Medical Faculty of Ege University, Izmir, Turkey. METHODS: A 55-year-old woman had neuropathic pain in her lower extremities after T12-L1 disc herniation surgery. The pain decreased to a tolerable level with conservative treatment and her condition remained stable for the following 6 months; then she developed swelling, redness and severe burning pain in both feet. Physical examination showed edema and redness in the feet. On the basis of clinical findings and Tc-99m methylene diphosphonate (MDP) three-phase bone scintigraphy, she was diagnosed to have CRPS. RESULTS: The patient underwent a diagnostic sympathetic ganglion blockade with bupivacaine, which resulted in a marked decrease in the pain and edema of the feet. Consequently, PRF lumbar sympatholysis was performed with a successful outcome in pain, edema and color changes in the feet. CONCLUSION: When treatment of CRPS fails with conventional modalities, PRF sympatholysis may be used for control of pain and other symptoms in such patients.
Subject(s)
Catheter Ablation/methods , Complex Regional Pain Syndromes/surgery , Ganglia, Sympathetic/surgery , Neurosurgical Procedures/methods , Spinal Cord Injuries/complications , Sympathectomy/methods , Arteries/innervation , Arteries/physiopathology , Complex Regional Pain Syndromes/etiology , Complex Regional Pain Syndromes/physiopathology , Diskectomy/adverse effects , Female , Ganglia, Sympathetic/physiopathology , Humans , Iatrogenic Disease , Middle Aged , Neurosurgical Procedures/instrumentation , Pain Measurement , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Postoperative Complications/surgery , Regional Blood Flow/physiology , Spinal Cord Injuries/etiology , Spinal Cord Injuries/physiopathology , Sympathectomy/instrumentation , Treatment Outcome , TurkeyABSTRACT
This case report demonstrates the importance of the CISS sequence, a fast imaging technique in MRI, in case of suspected nerve root avulsion. We present a case of traumatic pseudomeningoceles at T1-T2 root levels with right T2 ventral root avulsion without associated skeletal fracture diagnosed by MRI using the three dimensional CISS technique. A 28-year-old man presented to the Emergency Department following a motorcycle accident. Clinical examination revealed paresis in intrinsic muscles of the right hand. Traumatic pseudomeningoceles at T1-T2 root levels bilaterally with right T2 ventral root avulsion without associated skeletal fracture were diagnosed by three dimensional cervicothoracic MRI with CISS technique.