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Final Program


Final Program

1244 - Lumbar Sympathetic Block for Management of CRPS Type II in Incomplete T12 Spinal Cord Injury.

Thursday, February 27, 2025
5:00 PM - 6:30 PM MST

    Presenting Author(s)

  • AR

    Andrew Roberts, MD

    Medical Resident
    MedStar Health - Georgetown/National Rehabilitation Hospital
    BALTIMORE, Maryland, United States

    • Co-Author(s)

  • JS

    Jared Stowers, MD

    Resident Physician
    National Rehabilitation Hospital - - Washington, DC
    Arlington, Virginia, United States

  • JP

    James Pendleton, MD

    Attending Physician
    Medstar/Georgetown
    Washington, District of Columbia, United States

Case Diagnosis: CRPS Type II in Incomplete T12 Spinal Cord Injury

Case Description: The patient initially presented following a gunshot wound to the left flank resulting in L1 vertebral body fractures, right hepatic and renal lacerations, right psoas and retroperitoneal hematomas, and a T12 AIS spinal cord injury (SCI). Following surgery for removal of a retained bullet, his post-operative course was complicated by refractory neuropathic pain of the bilateral lower extremities. During his acute inpatient rehabilitation course, his pain with spasticity persisted, eventually becoming more prominent in the left foot and lower leg. He met Budapest Criteria for chronic regional pain syndrome (CRPS), demonstrating foot and lower leg allodynia, temperature and sweating asymmetry, skin color changes, and edema. He underwent left lumbar sympathetic block with significant ( >60%) pain reduction via his two-week post-procedure pain log and reported improved ability performing his activities of daily living (ADLs) including catheterization, cleaning, and cooking.

Discussions:

CRPS type II following traumatic SCI remains uncommon, with an estimated incidence of 5-10%. The mechanism of disease development is not fully understood, although thought to derive from a combination of inflammatory cytokine release, neurogenic inflammation, glial cell activation, oxidative damage, aberrant sympathetic outflow, and peripheral and central sensitization. Many of these mechanisms are reflected in the pathophysiology of SCI obfuscating recognition and diagnosis of CRPS in this population. Current treatment of these patients focuses on a multi-modal and multi-disciplinary approach and to our knowledge, this is one of the few well-documented cases of significant symptomatic improvement following lumbar sympathetic block for CRPS type II following traumatic SCI.

Conclusions:

SCI patients with refractory lower extremity neuropathic pain and symptomatology attributable to CRPS type II should be considered for lumbar sympathetic blockade, as it may greatly enhance therapeutic pain control, improving a patient’s ability to perform ADLs and overall quality of life.