REFLEX SYMPATHETIC DYSTROPHY AFTER OPERATIVE PROCEDURES ON THE LUMBARSPINE

Between July 1987 and April 1991, reflex sympathetic dystrophy develop ed in eleven patients after a posterior operation on the lumbar spine. The average age of the patients was forty-four years (range, twenty-e ight to sixty years). The preoperative diagnosis had been lumbar spond ylolisthesis or lumbar instability, associated with degenerative disc disease or with osteoarthrosis of a facet joint. Ten patients had post erior stabilization with bilateral arthrodesis and interpedicular fixa tion, with use of plates or screws; the remaining patient had a poster ior hemilaminotomy of the fourth and fifth lumbar vertebrae, partial d iscectomy, and foraminal decompression of the fifth lumbar-nerve root. After the operation, all patients had burning pain, vasomotor dysfunc tion, and dystrophic changes in the lower limb and foot; in four patie nts, the symptoms were bilateral. The symptoms began four days to twen ty weeks after the operation. The patients were followed for nine mont hs to four years. Treatment was most successful in four of six patient s who had had at least one nerve-block of the sympathetic lumbar trunk in addition to physiotherapy.