복합부위통증증후군 환자에서 척수자극술과 교감신경 고주파열응고술 -증례 보고-

Thoracic Spinal Cord Stimulation and Radiofrequency Thermocoagulation of Lumbar Sympathetic Ganglion in a Patient with Complex Regional Pain Syndrome in the Lower Extremity -A case report-

  • 김시현 (가톨릭대학교 의과대학 마취통증의학교실) ;
  • 문동언 (가톨릭대학교 의과대학 마취통증의학교실) ;
  • 박종민 (가톨릭대학교 의과대학 마취통증의학교실) ;
  • 유건희 (가톨릭대학교 의과대학 마취통증의학교실) ;
  • 서경수 (가톨릭대학교 의과대학 마취통증의학교실) ;
  • 유시현 (순천향대학교 의과대학 마취통증의학교실)
  • Kim, Shi Hyeon (Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University) ;
  • Moon, Dong Eon (Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University) ;
  • Park, Chong Min (Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University) ;
  • Ryu, Keon Hee (Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University) ;
  • Seo, Kyung Soo (Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University) ;
  • You, Sie Hyun (Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital)
  • 투고 : 2005.09.20
  • 심사 : 2005.12.05
  • 발행 : 2005.12.10

초록

Herein is described the successful treatment of complex regional pain syndrome type II with the combination treatment of spinal cord stimulation and radiofrequency thermocoagulation of the lumbar sympathetic ganglion. A 62 years old male patient, suffering from CRPS type II in his left lower extremity, visited our pain clinic. Medication and nerve blockade produced only slight improvement in his symptoms and signs. Therefore, a linear type spinal cord simulator was inserted into the thoracic epidural space, using a non-surgical percutaneous approach, with the cephalad lead located at the T11 level. Two months later, the repositioning of the electrode to the T12 level for more effective pain control, with radiofrequency thermocoagulation of lumbar sympathetic ganglion also performed at the left L2 and 3 levels for the control of trophic change. These resulted in significant pain relief and decreased trophic change, with no complications, after which the patient was able to resume a normal life.

키워드

참고문헌

  1. Wasner G, Schamchneider ], Binder A, Baron R: Complex regional pain syndrome-diagnostic, mechanisms, CNS involvement and therapy. Spinal Cord 2003; 41: 61-75.
  2. Walker SM, Cousins MJ: Complex regional pain syndromes: including "reflex sympathetic dystrophy" and "causalgia". Anaesth Intensive Care 1997; 25: [[3-25.
  3. Stanton-Hicks M, Baron R, Boas R, Gordh T, Harden N, Hendle N, et al: Complex Regional Pain Syndromes: guidelines for therapy. Clin ] Pain 1998; 14: 155-66.
  4. RJ,O RH, Brewer RP, Lamer T], Wilson PR: Complex regional pain syndrome. Mayo Clin Proc 2002; 77: 17-1-80.
  5. Birklein F: Complex regional pain syndrome. ] Neurol 2005; 252:131-8
  6. Garber BS, Bruehl S, Harden RN: IASP diagnostic criteria for complex regional pain syndrome: a preliminary empirical validation study, Clin .l Pain 1998; 14: 48-54.
  7. Baron R, ] anig W: Complex regional pain syndromes-how do we escape the diagnostic trap) Lancet 2004; 364: 1739-41.
  8. Turner ]A, Loeser ]D, Deyo RA, Sanders SB: Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome: a systematic review of effectiveness and complications. Pain 2004; 108: 137-47.
  9. Turner ]A, Loeser ]D, Deyo RA, Sanders SB: Spinal cord stimulation for patients with failed back surgery syndrome or complex regional pain syndrome: a systematic review of effectiveness and complications. Pain 2004; 108: 137-47.
  10. Kemler MA, Barendse GA, van Kleef M, De Vet HC, Rijks CP, Furnee CA, et al: Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl ] Med 2000; 3-13: 618-2-1.
  11. pain syndrome: a prospective srudy of 19 patient at two centers. Neuromodulation 1999; 2: 47-50.
  12. Oakley .lC, Prager ]P: Spinal cord stimulation: mechanisms of action. Spine 2002; 27: 2574-83.
  13. Yoon ]H, Moon DE, Lee CW, Ryu KH: Cervical spinal cord stimulation in a Patient with complex regional pain syndrome in the upper extremity. Korean] Pain 2004; 17: 243-7.
  14. Patel S, Huang DL, Sagher 0: Sympathetic mechanisms in cerebral blood flow alterations induced by spinal cord stimulation. ] Neurosurg 2003; 99: 754-61.
  15. Manola L, Holsheimer J, Veltink P: Technical Performance of percutaneous leads for spinal cord stimulation: a model study. Neuromoduation 2005; 2: 88-99 . https://doi.org/10.1111/j.1525-1403.2005.00224.x
  16. Villavicencio AT, Leveque .lC, Rubin L, Bulsara K, Gorecki ]P: Laminecromyversus percutaneous electrode placement for spinal cord stimulation. Neurosurgery 2000; 46: 399--105.
  17. Singh B, Moodley], Shaik AS, Robbs ]V: Sympathectomy for complex regional pain syndrome . .l Vasc Surg 2003; 37: 508-11.
  18. Chung K, Lee BH, Yoon YW, Chung ]M: Sympathetic sprouting in the dorsal root ganglia of the injured peripheral nerve in a rat neuropathic pain model, J Comp Neurol 1996; 376: 2-1 I-52.
  19. Yae SH, Han KR, Park KS: A case of treatment of complex regional pain syndrome Type II after peroneal nerve injury. Korean .l Pain 2002; 15: 183-9.
  20. Stanton-Hicks M: Radiofrequency techniques in clinical practice. Intervcnrionalpain management. 2nd ed. Edited by Waldmann SD. Philadelphia, WB Sauders Company. 2001, pp 243-93.