1. 2005;8;319-322Post-Lumbar Surgery Complex Regional Pain Syndrome
   A Case Report
   David E. Fish, MD.

Background: This case report identifies a patient with complex regional pain syndrome Type 2 (causalgia) with sympathetically maintained pain in a distal extremity associated with an anterior sacroiliac fusion with local bone graft.

Case Description: A 65-year-old man underwent a sacroiliac fusion for chronic back pain that was temporarily relieved with percutaneous injections to the joint space and lower lumbar facets. The successful surgery with allograft had no intraoperative complications. The patient remained in the hospital post-operatively for four days with no complications. Four to six weeks post-operative, the patient began to have swelling and pain of the ipsilateral foot. The pain progressed with evidence of allodynia, hyperesthesia, and dystrophic changes in the foot. EMG and a nerve conduction study showed severe denervation that involved not only the muscles below the knee but the quadriceps as well, with ongoing irritability of a number of muscles, including those innervated by the femoral, sciatic, and gluteal nerves in the left leg.  A diagnosis of complex regional pain syndrome Type 2 (causalgia) was made with the aid of a bone scan. A series of two diagnostic percutaneous chemical sympathectomies were undertaken, and the pain was significantly relieved. This suggested complex regional pain syndrome Type 2 with sympathetically maintained pain. The patient underwent aggressive physical therapy during rehabilitation; subsequent resolution of the pain syndrome occurred.

Conclusion: Complex regional pain syndrome 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.

Keywords: Sacroiliac, low back pain, CRPS, rehabilitation