COMPLEX REGIONAL PAIN SYNDROME TYPE-2 (CAUSALGIA) AFTER AUTOMATED LASER DISKECTOMY - A CASE-REPORT

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.