Successful Treatment of Neuropathic Pain with Pulsed Radiofrequency Treatment which Is Induced by PMMA Leakage during Percutaneous Vertebroplasty

초록

A 73-year-old woman with a history of L5 osteoporotic compression fracture treated with percutaneous vertebroplasty at another hospital was admitted due to severe lower extremity pain. Postoperative computed tomography (CT) revealed extravasation of polymethylmethacrylate (PMMA) into the central spinal canal and to the left L5–S1 foramen. She complained of spontaneous ongoing pain, hyperalgesia with electric shock-like sensations over the left L5 and S1 dermatomes and sleep disturbance. The authors confirmed that she has neuropathic pain according to the Leeds assessment of neuropathic symptoms and signs Pain Scale (18) and the Douleur Neuropathique 4 questionnaire score (7). Surgical treatment was reserved after careful consideration of the issues such as delayed time of the PMMA leakage, no further progression of motor weakness (grade 4/5) and development of neuropathic pain. Instead, pharmacological treatment was started with administration of gabapentin and tramadol hydrochloride, but she partially responded to the medications. Thus, we decided to proceed with nerve blocks and observed much improvement of symptoms. Then, pulsed radiofrequency treatment was subsequently performed. The patient’s symptoms were controlled to a tolerable level without further medications or interventions during a 1-year follow up period.

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