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Reflex sympathetic dystrophy associated with low lumbar disc herniation

P M Bernini, F A Simeone

    Spine
    |March 1, 1981
    PubMed
    Summary

    Reflex sympathetic dystrophy, often linked to lumbar disc herniation, involves complex nerve pathways. Diagnosis is supported by clinical signs, imaging, and response to sympathetic blocks, with treatment including nerve decompression and blockade.

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    Area of Science:

    • Neurology
    • Pain Medicine
    • Spinal Surgery

    Background:

    • Reflex sympathetic dystrophy (RSD), now known as complex regional pain syndrome (CRPS), is a debilitating condition.
    • Lumbar disc herniations are a common cause of low back pain and radiculopathy.
    • The relationship between spinal pathology and complex pain syndromes is an area of ongoing research.

    Observation:

    • Patients with lumbar disc herniations may present with symptoms suggestive of reflex sympathetic dystrophy.
    • Clinical manifestations include vasomotor instability in the affected limb.
    • Radiographic evidence such as osteopenia on plain roentgenograms and increased bone scan uptake can support the diagnosis.

    Findings:

    • Both central and peripheral neuroanatomic pathways are implicated in the development of RSD associated with lumbar disc herniations.

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  • A positive response to sympathetic blocks is a key diagnostic and therapeutic indicator.
  • Nerve root decompression may alleviate symptoms, but often requires adjunctive lumbar sympathetic blockade.

    • Implications:

    • Understanding the neuroanatomic basis of RSD in lumbar disc herniation is crucial for accurate diagnosis.
    • Multimodal treatment strategies, including surgical decompression and sympathetic blockade, are essential for effective management.
    • Further research into the complex interplay between spinal disorders and CRPS can lead to improved patient outcomes.