Rhizotomy and endoscopic discectomy for chronic low back pain and acute radiculopathy in a stiff-person syndrome - case report

Abstract

INTRODUCTION: Stiff Person Syndrome (SPS) is a rare neurological disorder, first described in 1956 by Moersch and Woltman. The clinical picture has an insidious onset of classic findings of episodic painful spasms, hyperreflexia, axial muscle stiffness, progressing slowly to the proximal limb muscles. Painful hyperlordosis due to lumbar spine stiffness is a diagnostic characteristic of SPS. CASE REPORT: Male, 69 years old, with SPS for 40 years, referred by the neurologist to the spine surgeon because of failure to conservative management of chronic low back pain, progressively acute leg and gait impairment. Physical examination is difficult to perform in SPS because it triggers spasms. MRI presented zygoapophyseal joint, intervertebral discs and muscle degeneration, including a L4L5 cranial migrated herniated disc. Once there were no other effective ways to manage his axial and radicular pain, it was decided to perform percutaneous transforaminal endoscopic discectomy for L4L5 decompression, L3 to S1 dorsal ganglion root medial branch ablative radiofrequency rhizotomy to relieve facet pain and L2 dorsal sensory ganglion pulsed radiofrequency rhizotomy for modulation of chronic low back pain. One year postoperative follow up, the patient has showed improvement in the VAS and SF-36. CONCLUSION: Chronic pain reported by a patient must be addressed in the biological, psychological and social dimensions. Understanding the multidimensionality of the factors involved with pain allows planning less aggressive and highly efficient strategies in uncommon and off label patients, as in the case of SPS.