gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Value of lumbar sympathetic nerve trunk blockade within the treatment concept of the Complex Regional Pain Syndrome (CRPS) Type I

Stellenwert der lumbalen Grenzstrangblockade im Behandlungskonzept des Complex Regional Pain Syndrome (CRPS) Typ I

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  • corresponding author J. Schilauske - Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
  • S. Ruetten - Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
  • A. Lienert - Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke
  • G. Godolias - Ressort Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Anna-Hospital Herne, am Lehrstuhl für Radiologie und Mikrotherapie, Universität Witten/Herdecke

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSA.07.08

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc129.shtml

Published: May 8, 2006

© 2006 Schilauske et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Among neuropathic pains, the Complex Regional Pain Syndrome (CRPS) Type I is a disease pattern which is hard to diagnose and to treat. Care must be taken to differentiate diagnostically between Sympathetically Maintained Pain (SMP) and Sympathetically Independent Pain (SIP). For treatment, in addition to physio- and psychotherapeutic and drug treatments, procedures of interventional pain therapy, like lumbar sympathetic nerve trunk blockade are available. The objective of this prospective study was to investigate the value of lumbar sympathetic nerve trunk blockade within the treatment concept of CRPSI.

Methods: 19 patients with CRPS I of the lower extremities following the initial damaging event were treated in 2004 with ct-controlled lumbar sympathetic nerve trunk blockade. 6 patients had undergone an arthroscopic operation of the knee or ankle in the past, 9 had suffered trauma with consecutive cast and 4 an ankle distorsion. All patients underwent max. 2 cycles of 3 sympathetic nerve trunk blockades. The follow-up period lasted 12 months. 18 patients could be followed. In addition to general parameters and psychometric tests, the VAS was used to rate pain.

Results: There were no complications. All signs of positive blockade of the sympathetic nerve trunk were seen in 72%. 5 patients reported subjective improvement in pain after 3 blockades (improvement in VAS by at least 40). 2 patients attained a subjective improvement in the VAS of at least 30 after a second cycle at 8 weeks. 6 patients had no longer-lasting improvement, even after the 2nd cycle, but reported brief pain reduction each time. These 13 patients can be considered under SMP based on this response, even though the response to the sympathetic nerve trunk blockade was short-lived. An SIP must be assumed in the remaining 5 patients.

Conclusions: Lumbar sympathetic nerve trunk blockade may be a meaningful addition to the treatment and especially in diagnostics of CRPS Type I. It is a decisive criterion in the differentiation between SMP and SIP. The preinterventional prediction of therapeutic success is limited. For this, long-term results and a check of the diagnosis must be further observed and specified.