Allodynia corresponding to the levels of cervical cord injury treated by surgical decompression: a report of 3 cases.

BACKGROUND

The role and timing of surgical decompression for SCI remains controversial, when the surgical outcomes are evaluated only by neurologic recovery. Other than neurologic deficits, severe pain after SCI is a significant problem, deteriorating the patient's activity of daily living. In the present report, allodynia of patients' upper limbs caused by cervical SCI was treated successfully by surgical decompression.

CASE DESCRIPTIONS: Three male patients received cervical SCI through minor accidents. They complained of allodynia and motor dysfunction at the spinal level compressed by preexisting lower cervical spondylosis, but they lacked symptoms or neurologic abnormalities below that spinal level. Severe pain was induced by soft touch or exposure to water at room temperature preoperatively. Surgical decompressions of the spinal cord and nerve roots were performed between 20 and 83 days (mean, 48.7 days) after the SCI. Allodynia was reduced in all patients immediately after surgery. Pain induced by soft touch disappeared within 4 days of operations, whereas pain by water exposure diminished within months. Recurrence of allodynia has not been observed in patients at least until the last follow-up, within periods ranging from 15 to 39 months (average, 26 months). The mean preoperative VAS was 6.0, and this improved to 2.2 at 1 month and 0.8 at the final follow-up.

CONCLUSION

We propose that patients with SCI with allodynia and motor dysfunction of the upper limbs related only to the compressed spinal levels are potentially treatable by surgical decompression.