R. Plancarte et O. Calvillo, COMPLEX REGIONAL PAIN SYNDROME TYPE-2 (CAUSALGIA) AFTER AUTOMATED LASER DISKECTOMY - A CASE-REPORT, Spine (Philadelphia, Pa. 1976), 22(4), 1997, pp. 459-461
Study Design. This report identifies a case of complex regional pain s
yndrome Type 2 (causalgia) with sympathetically maintained pain associ
ated with automated laser discectomy. The syndrome's clinical features
and its management with sympathectomy are described. Objectives. To r
eport an unusual complication associated with automated laser discecto
my, review the possible mechanism, and discuss the management of compl
ex regional pain syndrome Type 2 with sympathetically maintained pain.
Summary of Background Data. Automated laser discectomy represents a m
inimally invasive technique to treat herniated intervertebral discs. B
y using small, automated probes placed in the disc under local anesthe
sia and fluoroscopic guidance, disc material can be removed percutaneo
usly, eliminating the need for lumbar laminectomy with its attendant m
orbidity. Some complications have been reported, This case report pres
ents a complication not previously described. Methods. A 39-year-old w
oman underwent L4-L5 automated laser discectomy; an attempt was made t
o lase the L5-S1 disc, but the procedure was aborted because of severe
pain and discomfort. The patient had pain the left lower extremity in
the L5 and S1 distribution, including the foot. There was evidence of
allodynia and hyperesthesia with some dystrophic changes in the foot.
A diagnosis of complex regional pain syndrome Type 2 (causalgia) was
made. Results. A series of two diagnostic percutaneous chemical sympat
hectomies were undertaken, and the pain was relieved to a significant
extent for up to 2 weeks. This suggested complex regional pain syndrom
e Type 2 with sympathetically maintained pain, and thereafter therapeu
tic chemical sympathectomy resulted in resolution of the pain syndrome
. Conclusions. Complex regional pain syndrome Type 2 with sympathetica
lly maintained pain is a condition thar can result in serious disabili
ty and can be associated with a number of spinal procedures, including
automated laser percutaneous discectomy. Early intervention is recomm
ended to provide long-term resolution of the condition.