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The Journal of Bone and Joint Surgery, Vol 75, Issue 5 721-725, Copyright © 1993 by Journal of Bone and Joint Surgery, Inc

JOURNAL CONTENTS

Reflex sympathetic dystrophy after operative procedures on the lumbar spine

BL Sachs, MR Zindrick and RD Beasley
Department of Orthopaedics, New England Medical Center, Boston, Massachusetts 02111.

Between July 1987 and April 1991, reflex sympathetic dystrophy developed in eleven patients after a posterior operation on the lumbar spine. The average age of the patients was forty-four years (range, twenty-eight to sixty years). The preoperative diagnosis had been lumbar spondylolisthesis or lumbar instability, associated with degenerative disc disease or with osteoarthrosis of a facet joint. Ten patients had posterior stabilization with bilateral arthrodesis and interpedicular fixation, with use of plates or screws; the remaining patient had a posterior hemilaminotomy of the fourth and fifth lumbar vertebrae, partial discectomy, and foraminal decompression of the fifth lumbar-nerve root. After the operation, all patients had burning pain, vasomotor dysfunction, and dystrophic changes in the lower limb and foot; in four patients, the symptoms were bilateral. The symptoms began four days to twenty weeks after the operation. The patients were followed for nine months to four years. Treatment was most successful in four of six patients who had had at least one nerve-block of the sympathetic lumbar trunk in addition to physiotherapy.
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