PM&R

PAIN AND SPINE MEDICINE

No. 212 Intradiscal Steroid Injection to Treat Patients With
Neuropathic Pain Due to Discogenic Low Back Pain.
Aydemir Koray; Yavuz Ferdi; Taskaynatan Mehmet Ali (Gulhane Military Medical Academy, Taf Rehabilitation Center
Department of PMR, Ankara, Turkey).
Disclosure: None. Objectives: An objective of this study was to
investigate the effectiveness of intradiscal steroid injection in the treatment of discogenic low back pain (DLBP) with neuropathic pain (NEP).
Setting: Tertiary level hospital. Participants: A total of 18 patients
with DLBP were enrolled and divided into two groups based on having
NEP and not. Group 1 included 11 patients who had DLBP without NEP,
and group 2 included 7 patients who had DLBP with NEP. Main
Outcome Measures: Duration and intensity of LBP, the Quebec Back
Pain Disability Scale [QBPDS], the daily sleep interference scale [DSIS],
and a Leeds assessment of neuropathic symptoms and signs [LANSS]
pain scale. Level of Evidence: Level 3 evidence. Results: The mean
age of the 18 patients was 43.712.7 (range: 24-60) years. Of these
patients 9 (50%) were male. In our study 38.8% of the patients had
DLBP with NEP, whereas 61.2% had mainly nociceptive pain. As we
investigated the mean changes of the QBPDS scores and intensity of
LBP in patients with a LANSS score 12 a statistically signicant reduction
was found at the second week and third month after the treatment
compared to pre-injection values (p<0.05). The mean reduction in
the intensity of DLBP the QBPDS scores and the DSIS scores from
baseline to second week and third month after the treatment was greater in
group 2 than in group 1. However there was no signicant difference in the
mean reduction of the outcome parameters between the two groups
(p>0.05).

No. 213 Recurrent Complex Regional Pain Syndrome Type 1

With Bilateral Hand Involvement: A Case Report.
Koray Aydemir; Volkan Yilmaz, MD; Taner Dandinoglu;
Berke Aras (Gulhane Military Medical Academy, Department
of Physical Medicine and Rehabilitation, Ankara, Turkey).
Disclosure: None. Setting: Tertiary care university hospital. Patient: A
21-year-old male with bilateral upper extremity complex regional pain
syndrome (CRPS) type-1. Case Description: The patient was admitted
with complaints of swelling, sweating, and pain in both hands which
had begun spontaneously. He had similar symptoms three years before and
his complaints had healed spontaneously in 3 months. On physical examination the dorsum of both hands were cyanotic and swollen; the palmar
sides of both hands were cold and damp. Widespread allodynia and
hyperalgesia were noted. Periarticular osteoporosis of the hands were
observed on x-ray. Magnetic resonance imaging (MRI) ndings in the
carpal bones were compatible with CRPS. An arachnoid cyst in right cerebellar hemisphere and disorganization in the subcortical white matter in the
right parietal lobe were detected in brain MRI. Functional brain MRI
demonstrated an activity increase at the right parietal lobe. Slow theta
waves were observed in electroencephalography. Results: After 8 weeks
of physical therapy signicant improvements in hand function tests are
noted. Discussion: CRPS is usually provoked by a trauma or surgery but
a small proportion of patients develop CRPS without a clear causative event.
The underlying mechanisms are not yet clearly understood. In this case
report factors that might cause CRPS and cerebrocortical dysfunction in
CRPS are discussed. Non-routine methods for brain processing during
allodynia are also discussed. Conclusion: Bilateral recurrent CRPS is
a very rare clinical condition. Parietal brain dysfunction may explain the
central pain and allodynia in this case. Clinicians should consider central

Vol. 6, Iss. 8S2, 2014

S135

nerve system pathologies in evaluating idiopathic CRPS. Reprinted with

permission.
No. 214 Klippel-Feil Syndrome: A Case Report.
Koray Aydemir; Ismail Dede, MD; Ferdi Yavuz (Etimesgut Military Hospital, Department of Physical Medicine and Rehabilitation, Ankara, Turkey).
Disclosure: None. Setting: Secondary care hospital. Patient: A 24year-old male with Klippel-Feil syndrome (KFS). Case Description: The
patient presented to our clinic with neck and back pain with stiffness. His
pain had started one year ago while working. Over time the pain had spread
to the shoulders and the dorsal vertebrae. The pain was continuous and
aggravating with standing and walking. On physical examination; he had
facial asymmetry, torticollis, short neck, low hairline Sprengels deformity,
and cervicothoracal scoliosis. Cervical spine range of motion (ROM) was
decreased. Neurologic examination was normal. X-ray of the spine revealed
fusion of the C5 and C6 vertebrae, interdiscal space narrowing at C2 and C3
levels, bilateral rudimental cervical costae, and cervicothoracal scoliosis.
Ultrasound of the abdomen, echocardiogram, and audiometry were normal.
Assessments/Results: Exercises for scoliosis, cervical spine strengthening/ROM are started and non-steroidal anti-inammatory medicine is
prescribed. Modications in lifestyle are recommended. Improvements in
pain and functionality are observed. Discussion: KFS is a rare disease
characterized by the congenital fusion of any 2 of the cervical vertebrae.
Clinical triad of the disease consists of short neck, low hairline, and
decreased ROM of the cervical spine. Also systemic ndings like scoliosis,
kyphosis, Sprengels deformity, torticollis, craniofacial asymmetry, renal and
cardiac abnormalities, loss of hearing, and synkinesis may exist. Clinical
characteristics and the differential diagnosis of the KFS will be discussed.
Conclusion: Many of the people with KFS may be asymptomatic;
symptoms of the disease may develop during time. These patients should be
evaluated in terms of systemic pathologies. A multidisciplinary approach for
treatment and management for the accompanying abnormalities is recommended. Reprinted with permission.
No. 215 CRPS Type-2 as the Initial Clinical Manifestation of
Iatrogenic Sciatic Nerve Injury After Total Hip Arthroplasty:
A Case Report.
Koray Aydemir; Umut Guzelkucuk Asst. Prof, MD;
Serdar Kesikburun; Yasin Demir (Gulhane Military Medical
Academy Department of Physical Medicine and Rehabilitation Turkish Armed Forces Rehabilitation Center, Ankara,
Turkey).
Disclosure: None. Setting: Tertiary care university hospital. Patient: A
59-year-old female with iatrogenic sciatic nerve injury (SNI) after total hip
arthroplasty (THA). Case Description: The patient presented to our
clinic with complaints of severe pain, swelling, and sweating at her left foot.
She had a unilateral THA for congenital hip subluxation 2 weeks before.
Severe pain had started on her left foot one week after the surgery. Electromyogram (EMG), feet x-ray, and magnetic resonance imaging were
normal. She was inspected by dermatology and cardiovascular surgery
clinics but a specic disease could not be found. On physical examination;
allodynia, hyperalgesia, hyperemia, swelling and a non-dermatomal hypoesthesia on left foot were observed. Manual muscle testing was unreliable
due to the severe pain in left hip and left foot. 3-phase bone scan was
consistent with early period CRPS. With these clinical and scintigraphic
ndings, the patient was considered as CRPS and physical medicine and
rehabilitation programme is started. The EMG which was performed one
month after the surgery demonstrated a partial axonal degeneration on the
peroneal and total axonal degeneration on the tibial branches of the sciatic
nerve. Discussion: Femoral nerve and more commonly sciatic nerve
injuries are one of the most serious complications of the THA. CRPS type-2