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spinal cord stimulation and reflex
sympathetic dystrophy (rsd)
(medtronic)
What is reflex sympathetic dystrophy (RSD)?
RSD is a much debated clinical condition. It
ranges in severity from moderate to severs. It generally affects
patients who have suffered trauma, often minor, to a specific anatomic area.
Sometimes, patients won't even remember a specific injury.
Four criteria for RSD:
- diffuse pain in an area not corresponding to the
distribution of a peripheral nerve
- diminished function of the affected area
- stiffness of the involved joints
- characteristic skin and soft tissue changes
- early changes
- swelling
- rubor
- hyperhidrosis (increased sweating)
- warmth
- late changes
- atrophy
- stiffness
- coldness
- bone demineralization
Three clinical stages (corresponding to the physical
changes seen over time, as the disease progresses)
-
Stage I (early or acute)
- constant intense, burning pain disproportionate
to the injury
- accompanied by vasomotor instability, edema,
swelling
-
Stage II (intermediate or dystrophy)
- skin sensitivity
- shiny or discolored skin
- ridged or cracked nails
-
Stage III (late or atrophy)
- wasting
- atrophy of skin and subcutaneous tissues
- joint stiffness
- osteoporosis
Causes of RSD are poorly understood
Diagnosis is primarily clinical; there is no
universally accepted test
Following are tests often ordered but not
diagnostic of the condition
- triple phase bone scans
- thermography
- indium scanning
- x-ray bone densitometry
***One Common feature of RSD: improvement in
pain after blockade of sympathetic outflow to the affected anatomic area
Often the blockade is temporary (local anesthetics) or
permanent (surgical or chemical sympathectomy)
Some patients experience recurrence even after
permanent lesioning of sympathetic outflow
Conclusion (Kumar et al: Neurosurgery, March, 1997)
"Spinal cord stimulation is an effective treatment
for the pain of RSD. The low morbidity of this procedure and its
efficacy in patients failing surgical sympathectomy suggest, in our
opinion, that spinal cord stimulation is logically superior to ablative
sympatholysis in the management of RSD."
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