Disclosures: Ana V. Cintron-Rodriguez, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 58-year-old male with Phantom Radiculopathy.

Case Description or Program Description: A 58-year-old patient with lumbar radiculopathy pain which developed 18 years after a left traumatic transfemoral amputation. This patient ambulated with prostheses for many years,  however ceased for more than a year secondary to pain. Pain radiated through the residual limb to the amputated foot.

Setting: Tertiary care hospital.

Assessment/Results: Lumbar Magnetic Resonance Imaging(MRI):  lumbar spondylosis, Multilevel disc desiccation, bilateral foraminal stenosis and facet arthropathy. Electrodiagnostic evidence suggestive of a left lumbosacral radiculopathy (no current guidelines for diagnosis in amputee patients). Patient without response to conservative managment. TFESI was performed per 2 with good long lasting relief and he was able to start prosthetic retraining.

Discussion (relevance): The goal of rehabilitation after an amputation is to help the patient return to the highest level of function and independence possible while improving the overall quality of life—physically, emotionally, and socially; this includes pain management to avoid decline in functionality. Pain control starts immediately after surgery and throughout the lifetime of the patient. While post surgical phantom limb pain is common, phantom radiculopathy remains not well described in literature. To the best of our knowledge, our patient’s chronicity of presentation is unique and demonstrates that multifactorial pain generators can be superimposed. New onset pain should elicit a thorough evaluation including further diagnostic studies: Electrodiagnostic and MRI. Start with conservative management: Physical therapy, neuropathic medication: Gabapentin and Tetracyclines, and observe for response.TFESI is a minimally invasive procedure that may provide immediate relief as well as long term benefits. As well has dual potential as diagnostic tool and treatment for phantom radiculopathy.

Conclusions: Early recognition of Phantom Radiculopathy in amputee patients is paramount in order to prevent delay of treatment and promote functionality.  TFESI is a minimally invasive procedure and may provide immediate relief.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/case-report-transfemoral-amputee-with-rare-presentation-of-phantom-radiculopathy-treated-with-fluoroscopic-transforaminal-epidural-spinal-injection-tfesi/