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.
CASE DESCRIPTION: 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.
CONCLUSION:
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.