1404 - Dual Burden, Single Solution: DRG for Restless Leg and Chronic CRPS in a Patient with SCS History

Case Diagnosis: Restless leg syndrome (RLS) refractory to medical management, successfully treated with Dorsal Root Ganglion Stimulation (DRG-S) in a 67-year-old woman with comorbid Chronic Regional Pain Syndrome type II (CPRS-II)

Case Description: A 67-year-old woman developed focal neuropathic foot pain after multiple ankle surgeries complicated by common peroneal nerve injury, leading to disability, chronic low-back pain, and refractory RLS with periodic limb movements. Lower-extremity EMG/NCS was normal, and lumbar MRI showed degenerative changes without root compression. She met Budapest criteria for CRPS-II, exhibiting sensory, vasomotor, sudomotor/edema, and motor/trophic findings. Conservative management—including physical therapy, pharmacologic agents, peripheral nerve blocks, and cryoneurolysis—provided transient benefit. Thoracic spinal cord stimulation (SCS) improved axial back pain by ~70% but failed to alleviate distal foot dysesthesias and exacerbated paresthesias at higher amplitudes. A left L5 and S1 DRG-S trial yielded 70–90% pain relief. Permanent implantation resulted in clinical improvement including, reduction in Oswestry Disability Index (ODI) from 40 to 22, pain score reduction(VAS 9/10 to 3/10), and 95% pain improvement. She reported near-complete resolution of foot paresthesias and substantial reduction in RLS symptoms, enabling better sleep and mobility.

Discussions: CRPS-II and RLS may share overlapping mechanisms of peripheral afferent hyperexcitability and central sensitization. CRPS-II often follows injury with inflammatory and neuropathic features, whereas RLS involves impaired nociceptive and sensorimotor inhibition. DRG-S provides targeted neuromodulation at the nerve root level, enabling precise regional control. Clinical evidence supports DRG-S over SCS for focal neuropathic pain, especially in refractory CRPS, but data for RLS remain limited. Emerging case reports, including this one, highlight its potential therapeutic role in RLS with comorbid peripheral neuropathy.

Conclusions: This case illustrates a dual benefit of DRG-S in refractory CRPS-II and RLS, supporting its consideration in carefully selected patients and underscoring the need for further investigation.