Complex Regional Pain Syndrome Following Lumbar Discectomy

Kim, Do Hyun; Oh, Hyung Sug; Kim, Min Gi; Kim, Tae Wan; Park, Kwan Ho

doi:2017.3.1.22

Asian J Pain > Volume 3;2017 > Article

Case Report

Asian Journal of Pain 2017;3(1):22-26.
DOI: https://doi.org/10.35353/ajp.3.1.22 Published online May 30, 2017.

Complex Regional Pain Syndrome Following Lumbar Discectomy

Do Hyun Kim, Hyung Sug Oh, Min Gi Kim, Tae Wan Kim, Kwan Ho Park

Department of Neurosurgery, VHS Medical Center, Seoul, Korea

Correspondence: Kwan Ho Park, Tel: +82-2-2225-1363, Fax: +82-2-2225-4152,
Email: spineho@naver.com

Abstract

A 35-year-old man presented with back pain, radiating pain down to left leg. He had a past history of discectomy at L45 and L5S1 level. Left leg and foot pain was getting worse. We diagnosed herniated disc and performed discectomy at left L5S1level. He had had intractable pain, allodynia, and discolorization in left leg and foot. Lumbar magnetic resonance (MR) images showed post-laminectomy and epidural fibrosis. Three phase bone scan (TPBS) demonstrated increased blood flow and pooling at right leg and foot. Electromyography (EMG) study revealed left L5 radiculopathy. The patient had undergone various types of procedures. The spinal cord stimulation (SCS) system was implanted. Left leg and foot pain was improved slightly. Intrathecal morphine pump (ITMP) was implanted. The physical examination showed hyperalgesia and allodynia in left leg and foot. In other hospital, SCS system was removed and dorsal root entry zone (DREZ) lesioning was performed. And then SCS implantation was performed at T89 level. CRPS was partially under control with pharmacotherapy and surgeries including SCS, ITMP, and DREZ lesioning. The authors report a case of CRPS following lumbar discectomy.

Key Words: Discectomy; Complex regional pain syndrome; Spinal cord stimulation; Intrathecal morphine pump; Dorsal root entry zone lesioning