Study design: This report identifies a case of complex regional pain syndrome Type 2 (causalgia) with sympathetically maintained pain associated with automated laser discectomy. The syndrome's clinical features and its management with sympathectomy are described.
Objectives: To report an unusual complication associated with automated laser discectomy, review the possible mechanism, and discuss the management of complex regional pain syndrome Type 2 with sympathetically maintained pain.
Summary of background data: Automated laser discectomy represents a minimally invasive technique to treat herniated intervertebral discs. By using small, automated probes placed in the disc under local anesthesia and fluoroscopic guidance, disc material can be removed percutaneously, eliminating the need for lumbar laminectomy with its attendant morbidity. Some complications have been reported. This case report presents a complication not previously described.
Methods: A 39-year-old woman underwent L4-L5 automated laser discectomy; an attempt was made to lase the L5-S1 disc, but the procedure was aborted because of severe pain and discomfort. The patient had pain in 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 sympathectomies were undertaken, and the pain was relieved to a significant extent for up to 2 weeks. This suggested complex regional pain syndrome Type 2 with sympathetically maintained pain, and thereafter therapeutic chemical sympathectomy resulted in resolution of the pain syndrome.
Conclusions: Complex regional pain syndrome Type 2 with sympathetically maintained pain is a condition that can result in serious disability and can be associated with a number of spinal procedures, including automated laser percutaneous discectomy. Early intervention is recommended to provide long-term resolution of the condition.