J Korean Neurosurg Soc.  2014 Jul;56(1):66-70. 10.3340/jkns.2014.56.1.66.

Successful Treatment of Severe Sympathetically Maintained Pain Following Anterior Spine Surgery

• Woo JH
• Park HS

• KMID: 2067081
• DOI: http://doi.org/10.3340/jkns.2014.56.1.66

Abstract

Sympathetic dysfunction is one of the possible complications of anterior spine surgery; however, it has been underestimated as a cause of complications. We report two successful experiences of treating severe dysesthetic pain occurring after anterior spine surgery, by performing a sympathetic block. The first patient experienced a burning and stabbing pain in the contralateral upper extremity of approach side used in anterior cervical discectomy and fusion, and underwent a stellate ganglion block with a significant relief of his pain. The second patient complained of a cold sensation and severe unexpected pain in the lower extremity of the contralateral side after anterior lumbar interbody fusion and was treated with lumbar sympathetic block. We aimed to describe sympathetically maintained pain as one of the important causes of early postoperative pain and the treatment option chosen for these cases in detail.

Keyword

Anterior spine surgery; Sympathetic dysfunction; Sympathetic block

MeSH Terms

Burns
Diskectomy
Humans
Lower Extremity
Pain, Postoperative
Sensation
Spine*
Stellate Ganglion
Upper Extremity

Figure

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  Fig. 1 Preoperative T2 weighted cervical MRI shows herniated intervertebral disc at right paracentral and foraminal region of C6/7 (arrow).

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  Fig. 2 Postoperative anteroposterior (A), lateral (B) images reveal artificial disc replacement, C5/6 anterior cervical discectomy and fusion state and no evidence of mechanical failure of implanted instrumentation. Postoperative MRI (C) obtained after three operations shows good neural decompression and no evidence of unusual postoperative findings.

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  Fig. 3 Preoperative anteroposterior (A) and lateral (B) images of the lumbar spine reveal L3/4 and L4/5 spondylolisthesis. Preoperative T2 weighted lumbar MRI of L5/S1 level shows upward-migrated herniated intervertebral disc (arrow) at left foraminal region (C) and bilateral foraminal stenosis (D). Anteroposterior (E), lateral (F) images obtained after anterior lumbar interbody fusion, decompressive laminectomy and posterior fusion from L3 to S1.

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  Fig. 4 Images obtained during percutaneous epidural neuroplasty (A). It was performed especially focused on right L5/S1 foramen. MRI obtained after the third operation (B), showing the same level as Fig. 3C, revealed facetectomy and decompression state at right L5/S1 extraforaminal region.

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  Fig. 5 Anteroposterior (A) and lateral (B) images obtained during right lumbar sympathetic ganglion block.

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