Complex regional pain syndrome type II after cervical transforaminal epidural injection

Park, Gi-Young; Kwon, Dong Rak; Kwon, Dae Gil

doi:10.1097/md.0000000000010784

Cited by 6 publications

(13 citation statements)

References 16 publications

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“…There are 2 previously published case reports of CRPS after a cervical ESI, one after a transforaminal approach and one after an interlaminar approach (3,4). Though the likelihood of nerve root trauma would appear to be higher with the transforaminal approach, nerve root irritation and damage can also be possible with needle placement into the epidural space with the interlaminar approach.…”

Section: Discussionmentioning

confidence: 99%

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Complex Regional Pain Syndrome Type II After Cervical Interlaminar Epidural Injection

2021

PMCR

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BACKGROUND: Complex regional pain syndrome (CRPS) is a pain condition associated with autonomic and inflammatory features and is characterized by pain that is disproportionate in magnitude to the typical pain after similar injuries. The pathophysiology of CRPS is poorly understood, and many events have been implicated as causative factors. CASE REPORT: There are 2 previously documented case reports of CRPS after epidural steroid injections (ESI). This case report details the development of CRPS symptoms in a patient after receiving a cervical ESI. The precipitating event could have been trauma to a nerve root, nerve root irritation from the injectate, or contrast media reaction. Treatment focused on physical therapy and early intervention with a stellate ganglion block. The patient had complete resolution of her symptoms after 10 months. CONCLUSIONS: Although rare, CRPS due to direct nerve root injury or nerve root irritation can develop after an ESI; early diagnosis and treatment may result in a better outcome. KEY WORDS: Complex regional pain syndrome, CRPS, epidural steroid injections, TFESI, ILESI

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Section: Discussionmentioning

confidence: 99%

“…There are only 2 previously documented case reports of possible CRPS after an ESI (3,4). This case report details the development of symptoms consistent with acute CRPS in a patient after receiving a cervical interlaminar epidural injection for cervical radiculopathy.…”

Section: Introductionmentioning

confidence: 87%

Complex Regional Pain Syndrome Type II After Cervical Interlaminar Epidural Injection

2021

PMCR

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“…[6] There is also a case report describing complex regional pain syndrome type II after cervical TFESI. [7] Despite the controversy regarding its safety, cervical TFESI has distinctive merit in conservative treatment. Risks for complication are always present with the procedure because it is exceedingly difficult to identify all major structures of the neck-even under fluoroscopic guidance-and the needle may invade the internal jugular vein, or carotid and vertebral arteries.…”

Section: Discussionmentioning

confidence: 99%

Acute cervical myelopathy with quadriparesis after cervical transforaminal epidural steroid injection

et al. 2019

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Rationale: Cervical transforaminal epidural steroid injection (TFESI), can be an effective tool to improve pain associated with cervical radiculopathy. However, complications related to the procedure have been reported.Patient concerns: A 50-year-old woman who experienced acute cervical myelopathy with quadriparesis after cervical TFESI under fluoroscopic guidance.Diagnoses: The initial post-procedure cervical MRI revealed acute cervical myelopathy Interventions: She received 1000 mg of methylprednisolone was injected intravenously daily for 3 days Outcomes: Improvement in pain, with the only remaining complaints consisting of lingering mild pain in the left hand and occasional hypoesthesia Lessons: Cervical TFESI, despite careful fluoroscopic localization, resulted in spinal cord injury. A spinal cord injury may be treated with conservative treatments, such as medication and rehabilitation.

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“…It is characterized by pain that is irregular in intensity or duration relative to the general pain process and spontaneous or induced local pain originating from the distal parts of the extremities. [ 1 , 2 ]…”

Section: Introductionmentioning

confidence: 99%

“…CRPS type I presents without nerve damage and is known to be more common than CRPS type II. [ 2 – 4 ]…”

Section: Introductionmentioning

confidence: 99%

Complex regional pain syndrome type II caused by iatrogenic lateral dorsal cutaneous nerve injury

Kim

et al. 2021

Medicine

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Rationale: Complex regional pain syndrome (CRPS) is a painful condition classified as type I or II depending on the absence or presence of nerve injury, respectively. Injury to the lateral dorsal cutaneous nerve (LDCN), a branch of the sural nerve, is a rare occurrence observed after a sprain or procedures conducted on the lateral side of the ankle. Patient concerns: A 38-year-old female, who had undergone prolotherapy for a sprain in the lateral side of the left ankle 3 months ago, presented with persistent causalgia and dysesthesia around the injection site. Diagnosis: An electrodiagnostic study was conducted, which confirmed that the patient had peripheral neuropathy of the left LDCN. Considering the digital infrared thermal imaging and three-phase bone scan findings and the clinical presentation, the condition was diagnosed as CRPS type II due to iatrogenic LDCN injury according to the Budapest diagnostic criteria for CRPS. Interventions: The patient was treated with steroid pulse therapy, physical therapy, and transcutaneous electrical nerve stimulation, as well as nonsteroidal anti-inflammatory drugs, pregabalin, and tricyclic antidepressants. Outcomes: After 1 month of treatment, allodynia of the left foot persisted, but the pain reduced from 6 points to 3 points on the numeric rating scale. Partial recovery of amplitude and conduction velocity was confirmed in the follow-up electrodiagnostic study. Lessons: LDCN injury should be considered in patients who complain of persistent lateral ankle and foot paresthesia or pain after sprain or procedures performed on the lateral side of the ankle. Early diagnosis and treatment can lead to a good prognosis when the LDCN injury has progressed to CRPS.

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Complex regional pain syndrome type II after cervical transforaminal epidural injection

Cited by 6 publications

References 16 publications

Complex Regional Pain Syndrome Type II After Cervical Interlaminar Epidural Injection

Complex Regional Pain Syndrome Type II After Cervical Interlaminar Epidural Injection

Acute cervical myelopathy with quadriparesis after cervical transforaminal epidural steroid injection

Complex regional pain syndrome type II caused by iatrogenic lateral dorsal cutaneous nerve injury

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