Total knee arthroplasty in Brown-Séquard syndrome

Brown-Séquard syndrome (BSS) results from hemisection of the spinal cord, causing contralateral loss of pain sensation; pain arising from a limb contralateral to the injury is therefore neuropathic. Pain in osteoarthritis (OA) was traditionally considered to be nociceptive; however, a neuropathic element is being recognised, and may persist following total knee arthroplasty (TKA). Evidence contrasting the efficacy of arthroplasty in patients with nociceptive versus neuropathic pain is limited, and non-existent for BSS-we present the first case report of a patient with BSS undergoing TKA for severe neuropathic pain from OA. Following the failure of various conservative treatments, TKA was performed, and pain was measured with the EuroQol Visual Analogue Scale preoperatively (90), postoperatively day 1 (70), week 6 (40), week 12 (20) and 1 year (0), demonstrating significant improvement. This case report shows the efficacy of TKA in a patient with BSS, and shows TKA should be considered in such cases.