Poster 106: Postlumbar surgery complex regional pain syndrome: a case report.

Abstract

Setting: Tertiary care spine center. Patient: A 65-year-old man. 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 lumbar facets. This case report presents a complication not previously described for sacroiliac fusion surgery. The patient underwent a left sacroiliac arthrodesis for continued lumbosacral pain. The successful surgery with allograph had no intraoperative complications. The patient remained in the hospital postoperatively for 4 days with no complications. 4 to 6 weeks postoperative, the patient began to experience swelling and pain in the ipsilateral foot. The pain progressed with evidence of allodynia, hyperesthesia, and dystrophic changes in the foot. A diagnosis of complex regional pain syndrome (CRPS) type 2 (causalgia) was made with the aid of a bone scan. Assessment/Results: A series of 2 diagnostic percutaneous chemical sympathectomies were undertaken, and the pain was significantly relieved. This suggested CRPS type 2 with sympathetically maintained pain. The patient underwent aggressive physical therapy during his rehabilitation and subsequent resolution of the pain syndrome occurred. Discussion: This is an unusual complication associated with anterior sacroiliac fusion with local bone graft surgery. Complications including nerve compromise are more commonly seen. The presence of CRPS indicates that other central nervous system factors may be involved in the pathology of this disease. Conclusions: CRPS 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.