Phantom Radiculopathy: Case Report and Review of the Literature

Radicular Pain After Hip Disarticulation

“…7,8 Review of the cases described suggests that affected patients present with radicular pain, as early as 7 mos or as late as 40 yrs after amputation, often because of disc herniation at the L4-L5 or L5-S1 level. 4,[9][10][11] This case is unique in that this patient's phantom radiculopathy was secondary to extraforaminal nerve root compression by an osteophyte complex as compared with previously described cases. 4,9,10,12,13 Neurologic examination, nerve conduction studies, or electromyography of the affected limb in patients with amputation and radiculopathy is limited as one cannot assess for deficits in a dermatomal or myotomal pattern (Table 1).…”

“…4,[9][10][11] This case is unique in that this patient's phantom radiculopathy was secondary to extraforaminal nerve root compression by an osteophyte complex as compared with previously described cases. 4,9,10,12,13 Neurologic examination, nerve conduction studies, or electromyography of the affected limb in patients with amputation and radiculopathy is limited as one cannot assess for deficits in a dermatomal or myotomal pattern (Table 1). These limitations in examination and diagnostic tests highlight further the importance of imaging in patients with radicular pain after LLA (Table 2).…”

“…Phantom sensation refers to the nonpainful perception that the amputated limb remains, whereas residual limb pain refers to amputation site pain 7,8 . Review of the cases described suggests that affected patients present with radicular pain, as early as 7 mos or as late as 40 yrs after amputation, often because of disc herniation at the L4–L5 or L5–S1 level 4,9–11 . This case is unique in that this patient’s phantom radiculopathy was secondary to extraforaminal nerve root compression by an osteophyte complex as compared with previously described cases 4,9,10,12,13 …”

“…Although the patient had SIJ osteophytes bilaterally, sacroiliac steroid injection only provided modest relief for a short period. MRI aids, with greater sensitivity, in identifying structural causes of LBP that may be contributing to nerve root impingement among patients with LLA and trauma affecting multiple lumbopelvic joints 9 . Workup for another pain generator contributing to SIJ dysfunction led to obtaining this additional imaging, which revealed left L4–L5 foraminal stenosis due to disc osteophyte complex causing lumbosacral radiculopathy.…”

“…Previous treatment of phantom radiculopathy emphasized surgical management, including laminectomy with discectomy of the affected segment 9 (Table 2). Recently, fluoroscopically guided interlaminar or transforaminal ESI is used for patients with radicular pain refractory to conservative techniques 9,13,14 . ESI at two levels provided the most benefit for this patient, emphasizing the diagnostic and therapeutic benefit of ESI in radicular pain.…”