RSD Puzzle #129

H. Hooshmand, M. D.

DIPLOMATE AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY

BOARD CERTIFIED IN ELECTROENCEPHOLOGRAPHY

BOARD CERTIFIED IN ELECTROMYOGRAPHY

BOARD CERTIFIED IN AMERICAN BOARD OF ELECTODIAGNOSTIC MEDICINE

INTRACTABLE NEUROLOGY

EPILEPSY, PAIN, MS

An International Referral Center dedicated to Treatment, Education and Research

RSD PUZZLE # 129
CRPS (RSD) and Disc Protrusions

Question:

Dear Dr. Hooshmand,

I have been diagnosed with having full body CRPS II. I also have a small to moderate size central herniation of T7-8 minimally indenting the cord, and I have also had a neck fusion at C5-6 and C3-4 protruding outward, and mild facet arthritis at L4-5.

Answer:

Dear Ms. B,

The new name for RSD is CRPS, referring to the fact that the complex regional pain syndrome affects the entire region from hand or foot all the way to the spinal cord and spine causing inflammation and at times disc protrusions.

Undergoing surgery would be absolutely lunatic because surgery causes more inflammation and more bulging of the adjacent discs.

If surgery is done, then the adjacent vertebrae surrounding the removed disc undergo osteonecrosis. The term osteonecrosis refers to the meltdown of the bone. Many times the complications of osteonecrosis cause the patient to end up in a wheelchair because of an unstable spine.

The treatment of choice is epidural nerve blocks, I.V. Mannitol treatment, or treatment with Bumex.

Surgery is out of the question. Surgery on the disc herniation at the thoracic spine region, even in the absence of CRPS, has a very low percentage of success and can cause serious complications.

Sincerely,

H. Hooshmand, M.D.

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