目的:复杂区域疼痛综合征(CRPS)是一种使人衰弱的慢性疾病,伤害性疼痛以及各种其他症状。神经调节,特别是背根神经节(DRG)的电刺激,已成为对常规治疗无反应的CRPS患者的有希望的干预措施。然而,对CRPS患者DRGs的解剖学特征知之甚少。这项研究旨在评估CRPS患者与健康对照组的DRG大小。
方法:对12例有腰椎磁共振成像病史的单侧下肢CRPS患者进行了一项回顾性试验研究,并对DRG的大小进行了双边评估。患者年龄-,种族-,和性别匹配的对照组患者在匹配的脊柱水平无症状。DRG大小由神经放射学家评估。进行了包括配对t检验的统计分析,以比较CRPS患者及其匹配对照组对侧DRG大小的差异。
结果:患有CRPS的患者与未受影响的一侧相比,受影响一侧的DRG大小在统计学上显着减少(4.4mm-4.8mm,分别)。与健康对照组(4.9毫米-5.0毫米,分别)。此外,受影响侧和未受影响侧之间的平均DRG大小差异显示,CRPS患者的DRG大小差异(0.6mm差异)大于对照组患者的DRG大小差异(0.2mm差异).
结论:研究结果表明,在受影响的皮肤组中,CRPS与较小的DRG大小有关,可能表明神经元萎缩。重要的是,该研究为DRG刺激治疗提供了见解,尤其是在放置后对DRG压缩的关注中.这项初步研究表明,与对照组相比,CRPS患者的受影响侧和未受影响侧之间的DRG大小存在显着差异。强调对治疗CRPS的潜在影响。需要进一步的研究来验证这些发现并探索对临床实践的影响。包括优化的神经调节策略。
OBJECTIVE: Complex regional pain syndrome (CRPS) is a debilitating chronic condition characterized by severe, nociplastic pain along with various other symptoms. Neuromodulation, particularly electrical stimulation of the dorsal root ganglion (DRG), has emerged as a promising intervention for patients with CRPS unresponsive to conventional treatments. However, little is known about the anatomical characteristics of DRGs in patients with CRPS. This study aimed to assess DRG size in patients with CRPS compared with healthy controls.
METHODS: A retrospective pilot study was conducted in 12 patients with unilateral lower extremity CRPS who have a history of lumbar magnetic resonance imaging, and evaluated DRG sizes bilaterally. Patients were age-, race-, and sex-matched to patients in the control group who were asymptomatic at matched spinal level. DRG sizes were evaluated by a neuroradiologist. Statistical analyses including paired t-tests were performed to compare the difference in DRG size in contralateral sides in patients with CRPS and their matched controls.
RESULTS: Patients with CRPS exhibited a statistically significant reduction in DRG size on the affected side compared with the unaffected side (4.4 mm-4.8 mm, respectively). This difference was significant when compared with the difference observed in healthy controls (4.9 mm-5.0 mm, respectively). In addition, the mean DRG size difference between the affected and unaffected side showed a greater difference in DRG size in patients with CRPS (0.6 mm difference) than in control patients (0.2 mm difference).
CONCLUSIONS: The findings suggest that CRPS is associated with a smaller DRG size in affected dermatomes, potentially indicating neuronal atrophy. Importantly, the study offers insights for DRG stimulation therapy especially among concerns for DRG compression after placement. This pilot study reveals a significant size difference in DRGs between affected and unaffected sides in patients with CRPS compared with controls, highlighting potential implications for treating CRPS. Further research is warranted to validate these findings and explore implications for clinical practice, including optimized neuromodulation strategies.