Ann Rehabil Med.  2013 Dec;37(6):901-906. 10.5535/arm.2013.37.6.901.

Atypical Supernumerary Phantom Limb and Phantom Limb Pain in a Patient With Spinal Cord Injury: Case Report

• Choi JY
• Kim HI
• Lee KC
• Han ZA

• KMID: 2266572
• DOI: http://doi.org/10.5535/arm.2013.37.6.901

Abstract

Supernumerary phantom limb (SPL) resulting from spinal cord lesions are very rare, with only sporadic and brief descriptions in the literature. Furthermore, the reported cases of SPL typically occurred in neurologically incomplete spinal cord patients. Here, we report a rare case of SPL with phantom limb pain that occurred after traumatic spinal cord injury in a neurologically complete patient. After a traffic accident, a 43-year-old man suffered a complete spinal cord injury with a C6 neurologic level of injury. SPL and associated phantom limb pain occurred 6 days after trauma onset. The patient felt the presence of an additional pair of legs that originated at the hip joints and extended medially, at equal lengths to the paralyzed legs. The intensity of SPL and associated phantom limb pain subsequently decreased after visual-tactile stimulation treatment, in which the patient visually identified the paralyzed limbs and then gently tapped them with a wooden stick. This improvement continued over the 2 months of inpatient treatment at our hospital and the presence of the SPLs was reduced to 20% of the real paralyzed legs. This is the first comprehensive report on SPLs of the lower extremities after neurologically complete spinal cord injury.

Keyword

Phantom limb pain; Spinal cord injury; Tetraplegia; Neuropathic pain

MeSH Terms

Accidents, Traffic
Adult
Extremities
Hip Joint
Humans
Inpatients
Leg
Lower Extremity
Neuralgia
Phantom Limb*
Quadriplegia
Spinal Cord Injuries*
Spinal Cord*

Figure

• 

  Fig. 1 Neuroimaging of the spinal cord on the day of injury. Magnetic resonance imaging scan T2-weighted sagittal view (A), showing cervical cord signal change (arrow). Computed tomography scan sagittal (B) and axial views (C), revealing C6 vertebral body fracture.

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  Fig. 2 Cervical spine X-ray anterior-posterior view (A) and lateral view (B) were taken after first operation, C5-6-7 lateral mass fusion, performed on the day of injury. Cervical spine X-ray anterior-posterior view (C) and lateral view (D) were taken after the second operation, C5-6-7-T1 anterior and posterior fusion, performed 35 days after injury.

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  Fig. 3 Schematic representation of the phantom limb. Illusory lower limbs originate from the pelvic joints and extending at normal length medially to the patient's paralyzed legs.

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  Fig. 4 Visual-tactile stimulation treatment. The patient would first visually identify his paralyzed limbs and then gently tap his legs with a wooden stick.

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