[Case of painful muscle spasm induced by thoracic vertebral fracture: successful treatment with lumbar sympathetic ganglia block].
We report a 70-year-old man, who developed painful involuntary muscle contraction of the left leg after the lumbar discectomy, which exacerbated after a vertebral fracture of Th12. This involuntary movement was accompanied with the abnormal position of left leg simulating triple flexion response, and was induced by active or passive movement of his left knee and foot joints. Several drugs including benzodiazepines and dantrolene were ineffective, although treatment with baclofen or carbamazepine was effective. These findings suggest that hyperexcitability of the anterior horn cells following the disturbance of spinal inhibitory interneurons was involved. Electophysiological studies suggested the disturbance of left lumber nerve roots. The spinal root blocks from L3 to S1 were performed, after which the painful involuntary muscle spasm was resolved. The lumbar sympathetic ganglia block was also effective; suggesting that abnormal afferent neuronal input to spinal cord was caused by the nerve root trauma which triggered the formation of secondary abnormal network in the spine. Lumbar sympathetic ganglia block should be recommended to a therapeutic option for the refractory painful muscle spasm of the leg.
Shimizu
Fumitaka
F
Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine.
Kawai
Motoharu
M
Koga
Michiaki
M
Ogasawara
Jun-ichi
J
Negoro
Kiyoshi
K
Kanda
Takashi
T
D000368:Aged; D001340:Autonomic Nerve Block; D050815:Fractures, Compression / Q000150:complications*; D005728:Ganglia, Sympathetic; D006801:Humans; D007395:Interneurons / Q000502:physiology; D008159:Lumbar Vertebrae / Q000294:innervation*; D008297:Male; D010146:Pain / Q000209:etiology*; D059408:Pain Management; D013035:Spasm / Q000209:etiology* / Q000628:therapy*; D016103:Spinal Fractures / Q000150:complications*; D013904:Thoracic Vertebrae / Q000293:injuries*; D016896:Treatment Outcome