Hyperhidrosis and Dysautonomia in a Patient With a History of Tetraplegia Following Cervical Facet Radiofrequency Ablation.
Hyperhidrosis and Dysautonomia in a Patient With a History of Tetraplegia Following Cervical Facet Radiofrequency Ablation.
复制标题
颈椎小面射频消融后有四肢瘫痪病史的患者出现多汗和自主神经功能障碍。
DOI：
10.1002/pmrj.12168
复制
发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Chen,Jeffrey
中科院分区：
文献类型：
--
作者：
Reddy,Rajiv;Zardouz,Shawn;Rejai,Sepehr;Chen,Jeffrey
讨论：我们报告了一位颈椎融合术后有脊髓损伤病史的患者，他接受了颈椎射频消融术。随后，他出现了神经病理性疼痛，同侧有异位痛觉，伴有不稳定的血压和潮红，以及对侧多汗症。目前尚不清楚它们是相互关联的，还是由于不同的过程所致。目前尚不清楚左侧多汗症是如何由右侧失神经引起的。考虑到术后没有神经功能缺陷，并且确认了合适的针头位置，神经根或神经丛受损引起的神经病理性疼痛的可能性较小。例如，C4神经根的损伤可能会导致颈部疼痛，并伴有有限的运动障碍，但不能解释面部或手臂远端的疼痛。脊髓栓系或脊髓空洞形成是脊髓损伤后的并发症，但考虑到与手术的时间关系和症状的解决，这种并发症可能出现的可能性较小。交感神经纤维不太可能受到影响，因为它们位于椎体的前外侧。据报道，高达19%的患者会发生RFA后神经炎，被描述为“晒伤样”疼痛6。确切的机制尚不清楚，但被认为是感觉神经消融引起的去传入神经痛6。然而，神经炎本身可能与所报告的症状的程度和严重程度不一致。
DISCUSSION:We present a patient with a history of SCI status post cervical fusion with facet-mediated neck pain who underwent cervical RFA. He subsequently developed neuropathic-type pain with allodynia on the ipsilateral side with associated labile BP and flushing, and contralateral hyperhidrosis. It was unclear if they were linked, or due to separate processes. It remains mechanistically unclear how left-sided hyperhidrosis was precipitated by denervation of the right side. Given the absence of post-procedure neurological deficits and confirmed appropriate needle positioning, the neuropathic pain is less likely from lesioning of a nerve root or plexus. For example, a lesion of the C4 nerve root could cause neck pain with limited motor deficits, but would not explain the face or distal arm pain. Cord tethering or syrinx formation are complications after SCI, which could present similarly, however, is less likely given the temporal relationship to the procedure, and resolution of symptoms. It is unlikely that sympathetic nerve fibers were affected, as they reside anterolateral to the vertebral bodies. Post-RFA neuritis, which has been reported to occur in as many as 19% of patients, is described as “sunburn-like” pain 6. The exact mechanism is unknown, but thought to be deafferentation neuralgia from the ablation of the sensory nerves 6. However, neuritis alone would likely not be consistent with the extent and severity of the reported symptoms.