CRPS I following artificial disc surgery: case report and review of the literature

Abstract

We report a case of type 1 complex regional pain syndrome (CRPS I) of the left leg following the implantation of an artificial disc type in the L4/5 segment of the lumbar spine using a midline left-sided retroperitoneal approach. This approach included the mobilisation of the sympathetic trunk with incision and resection of the intervertebral disc. The perioperative and immediate postoperative periods were uneventful, but on the second postoperative day the patient complained of a progressive allodynia of the whole left leg in combination with weakness of the limb. Neurological examination did not reveal any radicular deficit or paresis. A sympathetic reaction following the mobilisation of the sympathetic trunk during the ventral preparation of the spine was suspected and investigated further. A diagnosis of CRPS I was proposed, and the patient was treated with analgesia, co-analgesics for pain alienation, and systemic corticosteroid therapy. A computed tomography-guided sympathetic block and lymphatic drainage were performed. Following conservative orthopaedic rehabilitation therapy, the degree of pain, allodynia, weakness, and swelling were reduced and the condition of the patient was ameliorated. The cost-benefit ratio of spinal arthroplasty is still controversial. The utility of this paper is to debate a possible cause of a painful complication, which can invalidate the results of a successful operation.

Complex regional pain syndrome following lateral lumbar interbody fusion

“…Complex regional pain syndrome has been reported after various posterior lumbar procedures, including decompression/ fusion, hemilaminectomy, microdiscectomy, and artificial disc implantation. 17,25 To the authors' knowledge, this is the first report of CRPS following a lateral lumbar approach. …”

“…Some have questioned the diagnostic rigor by which patients were assumed to have CRPS in this study. 14 Knoeller et al 17 reported a case of CRPS following an anterior midline retroperitoneal approach for implantation of a lumbar artificial disc at the L4-5 level. The patient postoperatively experienced pain and temperature changes associated with subjective weakness not confirmed by confrontational testing.…”

“…As the evidence for a sympathetic contribution to CRPS is far from definitive, this theory warrants consideration as well. Notably, Knoeller et al 17 did not consider this option and concluded sympathetic manipulation was the culprit. The artificial disc was placed at the L4-5 level in their patient, and they presumably performed extensive distraction of the vertebrae at those levels.…”

Complex Regional Pain Syndrome following Spine Surgery: Clinical and Prognostic Implications

“…Anyhow, CRPS I can also occur following spine surgery. One of the possible mechanisms might be a sympathetic reaction following the mobilization of the sympathetic trunk during ventral access to the spine, as the case of CRPS following lumbar disc prosthesis shows (tables 1, 2) [18]. …”

We Need to Talk about Lumbar Total Disc Replacement

“…The nonspinal complications of LTDR are classed as intraoperative (injury to ureter, nerves, 378 or large vessels 71,433 ) or postoperative (infection, 404 retrograde ejaculation, wound problems, hematoma, 71 formation of retroperitoneal lymphocele 401 ) and are common to all LTDR procedures that adopt an anterior lumbar surgical approach, irrespective of the LAD used. Although a less-invasive lateral approach 313,420 or a laparoscopic approach 430 for LTDR may impact the risk of the aforementioned and other complications, these innovations do not fulfill our a priori criteria for meaningful comment.…”