Treatment of post-lumbar sympathetic neurolysis neurologic complications using a transforaminal epidural block: A case report

Abstract

Background: A lumbar sympathetic ganglion block is useful for controlling neuropathic pain. Although the procedure is relatively safe, the use of chemical neurolytic agents may cause neurological complications. We underwent lumbar sympathetic ganglion neurolysis, and thereafter, neurological complications occurred. There is no specific treatment for neurologic complications after neurolysis using chemical agents, and a patient-specific approach is required. In this case, the pain intensity decreased step-by-step after transforaminal epidural block and interlaminar epidural block. We wrote about this treatment experience.Case presentation: A 45-year-old male patient underwent closed reduction and external fixation surgery for a left distal tibiofibular fracture and was subsequently diagnosed with complex regional pain syndrome. Lumbar sympathetic ganglion neurolysis was performed for treatment, but sensory loss of the L2 and L3 dermatomes and adductor muscle weakness of the lower leg occurred. Transforaminal epidural block and interlaminar epidural block were repeatedly performed to treat complications, and these procedures helped control the symptoms.Conclusions: When neurological complications occur after lumbar sympathetic neurolysis, an excellent therapeutic effect can be expected if transforaminal epidural block is used together with palliative treatment.