Disclosures: Michael Appeadu, MD: No financial relationships or conflicts of interest

Case Diagnosis: Complex Regional Pain Syndrome (CRPS) Type 1

Case Description: A 30-year-old man with T12 incomplete paraplegia secondary to multiple gunshot wounds (GSW) presented with severe bilateral lower extremity dysesthesias and muscle spasms. Symptoms failed to improve with oral antispasmodic medications. He uses an electric wheelchair for community ambulation and has bilateral equinus contractures. Motor strength was 0/5 in distal lower extremities, sensation to crude touch was diminished at the anterior thighs and below, patellar reflexes were 1+, and Modified Ashworth Score (MAS) was 0. CT imaging evidenced trauma at the L1 level and retained bullet fragments (RBF) in the right lower paraspinal area. The patient was diagnosed with CRPS type I secondary to SCI via GSW.

Setting: Tertiary care hospital outpatient clinic/ operating roomAssessment/

Results: Our patient underwent SCS trial, yielding an improvement of symptoms by greater than 80%. He subsequently underwent SCS implantation which produced equivalent results.

Discussion: GSW near the spinal cord may cause intractable chronic pain through spinal/nerve root transection, or reactive tissue formation resulting in nerve root compression from RBF. Spinal Cord Stimulation (SCS) is indicated for treating CRPS. Studies suggest that SCI patients who benefit from SCS have incomplete paraplegia with most pain below the lesioned level. SCS is also an effective treatment for chronic radicular pain secondary to RBF. While our patient was initially referred for baclofen pump evaluation for spasms, history and physical examination revealed a neuropathic source of pain and MAS of 0. Even in cases of severe spasticity in SCI, SCS has been suggested to be superior to intrathecal baclofen therapy.

Conclusion: Our case evidences SCS as an effective treatment option in a patient who developed CRPS type 1 after GSW resulting in SCI.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/spinal-cord-stimulation-for-crps-following-spinal-cord-injury-caused-by-multiple-gunshot-wounds/