Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of the painful muscle spasm induced by the thoracic vertebral fracture: Successful treatment with lumbar sympathetic ganglia block

Fumitaka Shimizu, M.D., Ph.D., Motoharu Kawai, M.D., Ph.D., Michiaki Koga, M.D., Ph.D., Jun-ichi Ogasawara, M.D., Ph.D., Kiyoshi Negoro, M.D., Ph.D. and Takashi Kanda, M.D., Ph.D.

Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine

We report a 70-year-old man, who developed painful involuntary muscle contraction of the left leg after the lumbar discectomy, which exacerbated after a vertebral fracture of Th12. This involuntary movement was accompanied with the abnormal position of left leg simulating triple flexion response, and was induced by active or passive movement of his left knee and foot joints. Several drugs including benzodiazepines and dantrolene were ineffective, although treatment with baclofen or carbamazepine was effective. These findings suggest that hyperexcitability of the anterior horn cells following the disturbance of spinal inhibitory interneurons was involved.
Electophysiological studies suggested the disturbance of left lumber nerve roots. The spinal root blocks from L3 to S1 were performed, after which the painful involuntary muscle spasm was resolved. The lumbar sympathetic ganglia block was also effective; suggesting that abnormal afferent neuronal input to spinal cord was caused by the nerve root trauma which triggered the formation of secondary abnormal network in the spine. Lumbar sympathetic ganglia block should be recommended to a therapeutic option for the refractory painful muscle spasm of the leg.
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(CLINICA NEUROL, 48: 733|736, 2008)
key words: painful muscle spasm, spinal root block, sympathetic ganglia block, inhibitory interneuron

(Received: 23-Jun-08)