Alejandro Rodriguez, MD
Resident Physician
UT Southwestern
Dallas, Texas, United States
Imran Murtuza, MD
Resident Physician
UT Southwestern
Dallas, Texas, United States
Chaitanya Konda, DO
Assistant Professor
UT Southwestern
Dallas, Texas, United States
57-year-old man experienced an accident at age 25 leading to left leg damage and the development of CRPS Type I of the left leg at 27.
A lumbar sympathetic RFA provided 15 years of pain relief. Left total knee arthroplasty at age 55 led to the return of left lower extremity pain. A spinal cord stimulator trial and L4-5 posterior fusion provided no pain relief.
At presentation, he reported constant, 8/10 intensity, stabbing, burning pain over the left knee radiating down the peroneal distribution of his foot with numbness, tingling, and cramping. Physical exam with allodynia, erythema in left leg from knee down to foot with shiny atrophic skin, nail bed changes on left foot, and antalgic gait on the left.
Left lumbar sympathetic ganglion tRFA achieved over 50% reduction in sensitivity allowing him to wear crew-length socks, improved standing, and walking with less intense pain exacerbations after longer activity.
Discussions:
Lumbar sympathetic ganglion tRFA is a viable option for managing CRPS of the lower extremity. While evidence supports its short to medium-term efficacy, further research is needed to establish long-term outcomes and optimal treatment protocols. A comprehensive, multidisciplinary approach remains crucial in the management of CRPS.
Conclusions:
Lumbar sympathetic ganglion tRFA can be an effective treatment for longstanding unilateral lower extremity CRPS Type I.
