Introduction: Complex Regional Pain Syndrome (CRPS) has a prevalence of 5.6 to 26 per 100,000 patient years. The prevalence in pediatric patients is not known. While pharmacologic, behavioral, and psychological treatments may be effective, in refractory CRPS, invasive treatments including sympathetic blocks and neurostimulation such as spinal cord stimulation (SCS) or dorsal root ganglion (DRG) stimulation must be entertained. The ACCURATE study demonstrated efficacy of DRG stimulation for the treatment of refractory CRPS, but there are no reported cases of its use in the pediatric population.
Methods: A literature search was performed concerning pediatric CRPS and SCS and DRG stimulation treatment options. Mentions of pediatric DRG cases were sought, but no descriptions of DRG stimulation utilized in pediatric CRPS were identified. We present the case of a 17 year-old female with CRPS Type I of the left ankle treated successfully with DRG stimulation.
Results: A 15 year-old female developed CRPS Type I of the left ankle after a sports injury. She was unable to wear a shoe or venture outside the home due to pain, swelling, and allodynia. She failed conservative treatments including medications, physical therapy, and lumbosacral sympathetic plexus blocks. At age 17, she underwent implantation of DRG stimulator leads targeting the left L4 and L5 nerve roots. She experienced 100% relief of pain within 4 days of placement. Improvements in mobility allowed her to reengage with physical therapy. By 6 months she was able to wear a shoe, ambulate with a walker, and participate in school activities; pain relief was maintained.
Conclusions: DRG stimulation has been shown to significantly alter the symptomatology in patients with CRPS. This case suggests DRG stimulation is as effective for the treatment of refractory CRPS in pediatric patients as in adults.
Patient Care: At this time, there are no reported cases of pediatric patients being treated for Complex Regional Pain Syndrome (CRPS) with dorsal root ganglion stimulation. We demonstrate that this is an effective treatment option for pediatric patients with refractory CRPS, and certainly this adds treatment options to the surgeons toolbox for this patient population.
Learning Objectives: 1) Define Complex Regional Pain Syndrome, the Budapest criteria, and differentiation of Type I and II CRPS.
2) Describe the prevalence of Complex Regional Pain Syndrome in adult and pediatric populations.
3) Review of the treatment options for CRPS, including DRG stimulation as an effective treatment in both the adult and pediatric population.