Complex Regional Pain Syndrome in a Patient with Muscular Dystrophy

Dear Editor We describe an adolescent patient with Becker muscular dystrophy (BMD) who exhibited complex regional pain syndrome type I (CRPS I) in both lower extremities that developed after instrumentation for scoliosis, together with bilateral achilloplasty. This patient was successfully treated with physical and massage therapy after a lumber epidural block via a caudally inserted epidural catheter. A 16-year old, 55 kg, 160 cm with the diagnosis of BMD was admitted to the orthopedic clinic with 90 degrees of thoracolumbar scoliosis and a disturbed body balance. He had not been able to walk for 6 years, and he underwent posterior instrumentation and fusion with lumbosacral fixation, together with bilateral achilloplasty, followed by bilateral below-knee casts for 3 weeks. After cast removal, the pharmacological therapies that were attempted included the analgesic tenoxicam (1 × 20 mg) and the co-analgesics amitriptyline (1 × 10 mg) and pregabalin (2 × 75 mg). Physical therapy was not attempted because of the patient's severe pain. At the second postoperative appointment, throracolumbosacral radiographies and computed tomography images were taken to rule out any hardware failure or malposition of pedicle screws, and serological tests were also repeated to rule out any infection secondary to the operation as he had complaints of pain of his both lower extremities that began during the postoperative period. He was admitted …