Session Information
Session Title: AA 2021 Virtual Posters - Pain and Spine Medicine
Session Time: None. Available on demand.
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
To cite this abstract in AMA style:
Appeadu M, Amirianfar E, Mata R, Price CN. Spinal Cord Stimulation for CRPS Following Spinal Cord Injury Caused by Multiple Gunshot Wounds [abstract]. PM R. 2021; 13(S1)(suppl 1). https://pmrjabstracts.org/abstract/spinal-cord-stimulation-for-crps-following-spinal-cord-injury-caused-by-multiple-gunshot-wounds/. Accessed September 7, 2024.« Back to AAPM&R Annual Assembly 2021
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/spinal-cord-stimulation-for-crps-following-spinal-cord-injury-caused-by-multiple-gunshot-wounds/