{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T11:53:14Z","timestamp":1793533994640,"version":"4.5.0"},"reference-count":42,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T00:00:00Z","timestamp":1670976000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Complex regional pain syndrome (CRPS) is a postoperative, misdiagnosed condition highlighted only by pain therapists after numerous failed attempts at pain control by the treating surgeon in the case of prolonged pain after surgery. It only occurs rarely after spine surgery, causing the neurosurgeon\u2019s inappropriate decision to resort to a second surgical treatment. Methods: We performed a systematic review of the literature reporting and analyzing all recognized and reported cases of CRPS in patients undergoing spinal surgery to identify the best diagnostic and therapeutic strategies for this unusual condition. We compare our experience with the cases reported through a review of the literature. Results: We retrieve 20 articles. Most of the papers are clinical cases showing the disorder\u2019s rarity after spine surgery. Most of the time, the syndrome followed uncomplicated lumbar spine surgery involving one segment. The most proposed therapy was chemical sympathectomy and spinal cord stimulation. Conclusion: CRPS is a rare pathology and is rarer after spine surgery. However, it is quite an invalidating disorder. Early therapy and resolution, however, require a rapid diagnosis of the syndrome. In our opinion, since CRPS occurs relatively rarely following spinal surgery, it should not have a substantial impact on the indications for and timing of these operations. Therefore, it is essential to diagnose this rare occurrence and treat it promptly and appropriately.<\/jats:p>","DOI":"10.3390\/jcm11247409","type":"journal-article","created":{"date-parts":[[2022,12,14]],"date-time":"2022-12-14T05:59:40Z","timestamp":1670997580000},"page":"7409","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Complex Regional Pain Syndrome after Spine Surgery: A Rare Complication in Mini-Invasive Lumbar Spine Surgery: An Updated Comprehensive Review"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6715-5395","authenticated-orcid":false,"given":"Umberto Aldo","family":"Arcidiacono","sequence":"first","affiliation":[{"name":"Human Neurosciences Department, Neurosurgery Division, \u201cSapienza\u201d University, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6550-5534","authenticated-orcid":false,"given":"Daniele","family":"Armocida","sequence":"additional","affiliation":[{"name":"Human Neurosciences Department, Neurosurgery Division, \u201cSapienza\u201d University, 00185 Rome, Italy"},{"name":"IRCCS \u201cNeuromed\u201d, 86077 Pozzilli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Pesce","sequence":"additional","affiliation":[{"name":"Neurosurgery Unit, Santa Maria Goretti Hospital, Via Guido Reni 1, 04100 Latina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Maiotti","sequence":"additional","affiliation":[{"name":"Villa Stuart Hospital, Orthopedic Clinic, 00135 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Proietti","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Institute of Orthopaedics, Universit\u00e0 Cattolica del Sacro Cuore, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giancarlo","family":"D\u2019Andrea","sequence":"additional","affiliation":[{"name":"\u201cSpaziani\u201d Hospital, 03100 Frosinone, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Santoro","sequence":"additional","affiliation":[{"name":"Human Neurosciences Department, Neurosurgery Division, \u201cSapienza\u201d University, 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8062-614X","authenticated-orcid":false,"given":"Alessandro","family":"Frati","sequence":"additional","affiliation":[{"name":"IRCCS \u201cNeuromed\u201d, 86077 Pozzilli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1097\/EJA.0000000000001448","article-title":"Pain management after complex spine surgery: A systematic review and procedure-specific postoperative pain management recommendations","volume":"38","author":"Waelkens","year":"2021","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"357","DOI":"10.3171\/2016.11.SPINE16526","article-title":"An analysis from the Quality Outcomes Database, Part 1. Disability, quality of life, and pain outcomes following lumbar spine surgery: Predicting likely individual patient outcomes for shared decision-making","volume":"27","author":"McGirt","year":"2017","journal-title":"J. Neurosurg. Spine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e0171","DOI":"10.2106\/JBJS.RVW.19.00171","article-title":"Advances in Techniques and Technology in Minimally Invasive Lumbar Interbody Spinal Fusion","volume":"8","author":"Jain","year":"2020","journal-title":"JBJS Rev."},{"key":"ref_4","first-page":"1377","article-title":"Complex regional pain syndrome: A focus on the autonomic nervous system","volume":"2020","author":"Birklein","year":"2019","journal-title":"Br. J. Anaesth."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.pain.2010.04.030","article-title":"Validation of proposed diagnostic criteria (the \u201cBudapest Criteria\u201d) for Complex Regional Pain Syndrome","volume":"150","author":"Harden","year":"2010","journal-title":"Pain"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1007\/s40291-019-00417-x","article-title":"Highlighting the Role of Biomarkers of Inflammation in the Diagnosis and Management of Complex Regional Pain Syndrome","volume":"23","author":"Bharwani","year":"2019","journal-title":"Mol. Diagn. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/0304-3959(95)00110-E","article-title":"Reflex sympathetic dystrophy: Changing concepts and taxonomy","volume":"63","author":"Hassenbusch","year":"1995","journal-title":"Pain"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"8182569","DOI":"10.1155\/2020\/8182569","article-title":"Prednisone for Acute Complex Regional Pain Syndrome: A Retrospective Cohort Study","volume":"2020","author":"Jamroz","year":"2020","journal-title":"Pain Res. Manag."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"721","DOI":"10.2106\/00004623-199305000-00012","article-title":"Reflex sympathetic dystrophy after operative procedures on the lumbar spine","volume":"75","author":"Sachs","year":"1993","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/S0002-9610(97)89623-7","article-title":"Lumbar sympathectomy for causalgia secondary to lumbar laminectomy","volume":"171","author":"AbuRahma","year":"1996","journal-title":"Am. J. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1097\/00007632-199702150-00021","article-title":"Complex regional pain syndrome type 2 (causalgia) after automated laser discectomy. A case report","volume":"22","author":"Plancarte","year":"1997","journal-title":"Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"319","DOI":"10.36076\/ppj.2005\/8\/319","article-title":"Post-Lumbar Surgery Complex Regional Pain Syndrome","volume":"8","author":"Fish","year":"2005","journal-title":"Pain Physician"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1016\/j.surneu.2007.02.003","article-title":"The outcome of percutaneous computed tomography-guided chemical lumbar sympathectomy for patients with causalgia after lumbar discectomy","volume":"69","author":"Lee","year":"2008","journal-title":"Surg. Neurol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e0694","DOI":"10.1097\/MD.0000000000010694","article-title":"Sacral epiduroscopic laser decompression for complex regional pain syndrome after lumbar spinal surgery A case report","volume":"97","author":"Jung","year":"2018","journal-title":"Medicine"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"253","DOI":"10.3233\/NRE-208001","article-title":"Complex regional pain syndrome: An updated comprehensive review","volume":"47","author":"Kessler","year":"2020","journal-title":"NeuroRehabilitation"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1111\/j.1526-4637.2010.00925.x","article-title":"Case Report Complex Regional Pain Syndrome Associated with Cervical Disc Protrusion and Foraminotomy","volume":"11","author":"Weisz","year":"2010","journal-title":"Pain Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1159\/000337907","article-title":"Complex regional pain syndrome following spine surgery: Clinical and prognostic implications","volume":"68","author":"Wolter","year":"2012","journal-title":"Eur. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1177\/2192568220941460","article-title":"Perioperative Complications of Minimally Invasive Transforaminal Lumbar Interbody Fusion (MI-TLIF): 10 Years of Experience with MI-TLIF","volume":"11","author":"Patel","year":"2021","journal-title":"Glob. Spine J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"413","DOI":"10.3171\/2015.2.SPINE14973","article-title":"Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: Meta-analysis and systematic review","volume":"24","author":"Goldstein","year":"2016","journal-title":"J. Neurosurg. Spine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1007\/s00586-011-1691-z","article-title":"CRPS I following artificial disc surgery: Case report and review of the literature","volume":"20","author":"Knoeller","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_21","first-page":"473","article-title":"Response","volume":"20","author":"Kanter","year":"2014","journal-title":"J. Neurosurg. Spine"},{"key":"ref_22","first-page":"E901","article-title":"Complex Regional Pain Syndrome Caused by Lumbar Herniated Intervertebral Disc Disease","volume":"19","author":"Kim","year":"2016","journal-title":"Pain Physician"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1302\/0301-620X.89B9.18939","article-title":"The nerve supply of the lumbar intervertebral disc","volume":"89","author":"Edgar","year":"2007","journal-title":"J. Bone Jt. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e57","DOI":"10.1016\/j.wneu.2021.08.127","article-title":"Minimally Invasive Transforaminal Lumbar Interbody Fusion Using Expandable Cages: Increased Risk of Late Postoperative Subsidence without a Real Improvement of Perioperative Outcomes: A Clinical Monocentric Study","volume":"156","author":"Armocida","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1093\/pm\/pny111","article-title":"Brain metabolites and peripheral biomarkers associated with neuroinflammation in complex regional pain syndrome using [11C]-(R)-PK11195 positron emission tomography and magnetic resonance spectroscopy: A pilot study","volume":"20","author":"Jung","year":"2019","journal-title":"Pain Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1097\/ALN.0000000000002130","article-title":"Neuroinflammation and central sensitization in chronic and widespread pain","volume":"129","author":"Ji","year":"2018","journal-title":"Anesthesiology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/j.jpain.2013.04.001","article-title":"Primary somatosensory cortex function in complex regional pain syndrome: A systematic review and meta-analysis","volume":"14","author":"McAuley","year":"2013","journal-title":"J. Pain"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1212\/WNL.27.8.791","article-title":"Bone scanning and diagnosis of reflex sympathetic dystrophy secondary to herniated lumbar disks","volume":"27","author":"Carlson","year":"1977","journal-title":"Neurology"},{"key":"ref_29","first-page":"745","article-title":"Douleurs persistantes apr\u00e8s sciatique discale: L\u2019algodystrophie, une complication inhabituelle \u00e0 rechercher. A propos de quatre cas [Persistent pain following discal sciatica: Reflex sympathetic dystrophy, an unusual complication to be examined. Apropos of 4 cases]","volume":"59","author":"Perrot","year":"1992","journal-title":"Rev. Rhum. Mal. Osteoartic."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1097\/01.brs.0000201324.45537.46","article-title":"Possible pathogenesis of painful intervertebral disc degeneration","volume":"31","author":"Peng","year":"2006","journal-title":"Spine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1097\/00007632-198103000-00014","article-title":"Reflex sympathetic dystrophy associated with low lumbar disc herniation","volume":"6","author":"Bernini","year":"1981","journal-title":"Spine"},{"key":"ref_32","first-page":"185","article-title":"Lumbosacral radiculopathy, reflex sympathetic dystrophy and tarsal tunnel syndrome: An unusual presentation","volume":"66","author":"Chodoroff","year":"1985","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1007\/BF01406664","article-title":"Sympathetic dysfunction in patients with persistent pain after prolapsed disc surgery. A thermographic study","volume":"89","author":"Hogenesch","year":"1987","journal-title":"Acta Neurochir."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1001\/archsurg.1987.01400180050009","article-title":"Sympathectomy for Causalgia: Patient Selection and Long-Term Results","volume":"122","author":"Mockus","year":"1987","journal-title":"Arch. Surg."},{"key":"ref_35","first-page":"595","article-title":"Reflex sympathetic dystrophy syndrome secondary to L5 radiculopathy","volume":"72","author":"Ballard","year":"1991","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_36","first-page":"61","article-title":"Reflex sympathetic dystrophy secondary to lumbar disk herniation","volume":"34","author":"Adachi","year":"1994","journal-title":"Clin. Neurol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1097\/00002517-199810000-00013","article-title":"Reflex sympathetic dystrophy associated with extraforaminal disc herniation at the L5-S1 level","volume":"11","author":"Condon","year":"1998","journal-title":"J. Spinal Disord."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"101","DOI":"10.4184\/asj.2009.3.2.101","article-title":"Is complex regional pain syndrome a cause of post-operative syndrome in the lumbar spine?\u2014A case report","volume":"3","author":"Chae","year":"2009","journal-title":"Asian Spine J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"502","DOI":"10.3171\/2013.7.SPINE12352","article-title":"Complex regional pain syndrome following lateral lumbar interbody fusion","volume":"19","author":"Morr","year":"2013","journal-title":"J. Neurosurg. Spine"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"7019196","DOI":"10.1155\/2016\/7019196","article-title":"Early treatment of acute complex regional pain syndrome after fracture or injury with prednisone: Why is there a failure to treat? A case series","volume":"2016","author":"Winston","year":"2016","journal-title":"Pain Res. Manag."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Rosado Caracena, R., Mendiola de la Osa, A., Rinc\u00f3n Higuera, A., Abad Fau de Casajuana, E., Ruiz C\u00f3rdoba, G., and Garc\u00eda de Lucas, F. (2022). Cervical dorsal root ganglion stimulation for complex regional pain syndrome: Technical description and results of seven cases. Pain Pract.","DOI":"10.1111\/papr.13183"},{"key":"ref_42","first-page":"521","article-title":"Parameters of Spinal Cord Stimulation in Complex Regional Pain Syndrome: Systematic Review and Meta-analysis of Randomized Controlled Trials","volume":"25","author":"Ho","year":"2022","journal-title":"Pain Physician"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/24\/7409\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:41:07Z","timestamp":1760146867000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/24\/7409"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,14]]},"references-count":42,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["jcm11247409"],"URL":"https:\/\/doi.org\/10.3390\/jcm11247409","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,14]]}}}