Case Diagnosis: Allodynia
Case Description: A 77 year old female presented to acute hospital 5 days after C4-C7 arthrodesis and fusion for cervical spondylosis and multiple herniated discs. After surgery she experienced progressive left arm pain and eventually hemiplegia. CT revealed facet fixation cage was anterior and medial in position encroaching on the left left C4-5 neural foramen, compromising the left C5 nerve root. She underwent hemi-laminotomy, foraminotomy, and removal of displaced DTRAX cage. After surgery patient had residual hemiparesis and new onset allodynia. On physical exam light touch of her arm provoked 10/10 pain. Patient’s pregabalin 150mg twice daily was increased to three times daily and diclofenac gel was added. Massage therapy, fluidotherapy, and anodyne therapy were utilized one hour per day. As patient’s hypersensitivity to pain decreased, she began to have gains in upper extremity strength. The patient subsequently experienced resolution of allodynia and had 4/5 strength throughout the affected extremity at discharge.
Allodynia is often associated with cervical radiculopathic pain. Since the mechanisms underlying cervical radiculopathic pain-associated allodynia are unclear, adequate treatment remains elusive. A multimodal approach incorporating a neuropathic pain medication such as pregabalin, anti-inflammatory medication such as diclofenac gel along with desensitization modalities like fluidotherapy and anyodyne therapy may serve as a good treatment regimen. As a result of decreased pain, functional gains can be made during therapy.