Her Yeng F, Churchill Robert A
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Mayo Clinic Alix School of Medicine, Mayo Clinic Hospital, Rochester, MN, 55905, USA.
Int Med Case Rep J. 2024 Aug 26;17:765-769. doi: 10.2147/IMCRJ.S477303. eCollection 2024.
We present on a patient with complex regional pain syndrome (CRPS) following ankle surgery. Pain was refractory to both conservative and surgical measures including neurotomies, ankle fusion, hardware removal, and spinal cord stimulation (SCS) trial. A dorsal root ganglion (DRG) stimulation trial with lead placements at L4, L5, and S1 provided significant pain and functional improvement. However, during the implantation, we were able to place only two DRG leads at L4 and L5 and not S1 due to difficulties with advancing the lead to the desired location. Nonetheless, the two DRG leads provided 90% pain relief and 75% functional improvement for 9 months. However, the patient experienced pain symptoms similar to that of pre-implant without a clear trigger after 9 months despite no DRG stimulator hardware malfunction or lead migration. A decision was made to re-try implanting the S1 DRG lead, which was successful and provided significant pain relief.
我们报告了1例踝关节手术后发生复杂性区域疼痛综合征（CRPS）的患者。疼痛对包括神经切断术、踝关节融合术、取出内固定装置以及脊髓刺激（SCS）试验在内的保守和手术措施均无效。在L4、L5和S1处放置电极的背根神经节（DRG）刺激试验使疼痛和功能得到了显著改善。然而，在植入过程中，由于将电极推进到理想位置存在困难，我们仅在L4和L5处放置了两根DRG电极，未在S1处放置。尽管如此，这两根DRG电极在9个月内使疼痛缓解了90%，功能改善了75%。然而，9个月后，尽管DRG刺激器硬件没有故障且电极也未移位，但患者仍出现了与植入前类似的疼痛症状，且无明显诱因。于是决定再次尝试植入S1 DRG电极，此次植入成功并使疼痛得到了显著缓解。
