Post-lumbar surgery complex regional pain syndrome.
BACKGROUND
This case report identifies a patient with complex regional pain syndrome Type 2 (causalgia) with sympathetically maintained pain in a distal extremity associated with an anterior sacroiliac fusion with local bone graft.


METHODS
A sacroiliac fusion was undertaken due to chronic back pain that was temporarily relieved with percutaneous injections to the joint space and lower lumber facets. A 65 year-old man underwent a left sacroliac arthrodesis for continued lumbosacral pain. The successful surgery with allograft had no intraoperative complications. The patient remained in the hospital post-operatively for four days with no complications. Four to six weeks post-operative, the patient began to have swelling and pain at the ipsilateral foot. The pain progressed with evidence of allodynia, hyperesthesia, and dystrophic changes in the foot. EMG and a nerve conduction study showed severe denervation that involved not only the muscles below the knee but the quadriceps as well, and also had ongoing irritability of a number of muscles, including those innervated by the femoral, sciatic, and gluteal nerves in the left leg. A diagnosis of complex regional pain syndrome Type 2 (causalgia) was made with the aid of a bone scan. A series of two diagnostic percutaneous chemical sympathectomies were undertaken, and the pain was significantly relieved. This suggested complex regional pain syndrome Type 2 with sympathetically maintained pain. The patient underwent aggressive physical therapy during his rehabilitation and subsequent resolution of the pain syndrome occurred.


CONCLUSIONS
Complex regional pain syndrome Type 2 with sympathetically maintained pain is a condition that can result in serious disability and can be associated with spinal procedures and sacroiliac arthrodesis. Early intervention is recommended to provide long-term resolution of the condition.
Fish
David E
DE
Department of Anesthesiology and Pain Management, Portsmouth Naval Medical Center 620, John Paul Jones Circle Portsmouth, VA 23708, USA. dfish@mednet.ucla.edu