Case Study Research Project: Anatomical and Pathophysiological Findings in a Cadaver with a Spinal Cord Stimulator and Chronic PASH Syndrome, Critical Illness Myopathy, and Reflex Sympathetic Dystrophy.

Moultrie, GA

Introduction:

Spinal cord stimulators (SCS) are commonly used for neuropathic pain management, particularly in conditions such as reflex sympathetic dystrophy (RSD)/complex regional pain syndrome (CRPS). However, the long-term anatomical and histopathological changes in patients with SCS and multiple comorbidities remain poorly understood. This case study investigates the postmortem findings of a cadaver with a documented history of chronic PASH syndrome (pyoderma gangrenosum, acne, hidradenitis suppurativa), critical illness myopathy (CIM), and RSD/CRPS, all of which contributed to the patient’s cause of death.

Methods:

A comprehensive cadaveric examination was performed in the anatomy laboratory at Philadelphia College of Osteopathic Medicine - South Georgia on an 81-year-old male cadaver , including gross anatomical dissection, histopathological analysis of muscle, nerve, and skin tissues, and evaluation of the SCS placement and its surrounding tissue response. Special attention was given to muscle atrophy and fibrosis (CIM-related), peripheral nerve degeneration (RSD/CRPS-related), and chronic inflammatory skin lesions (PASH-related).

Results:

Preliminary findings suggest fibrotic encapsulation of the SCS leads, indicative of chronic inflammatory response. A reduction in muscle size and mass, likely due to prolonged illness or disuse, which is common in critical illness myopathy (CIM). The replacement of muscle tissue with fat, a hallmark of CIM, indicating chronic muscle degeneration.Structural damage or deterioration of nerves, which is commonly associated with reflex sympathetic dystrophy (RSD)/complex regional pain syndrome (CRPS) and can contribute to chronic pain and sensory abnormalities.

Discussion:

This cadaveric case study provides rare and valuable insights into the complex interplay between chronic inflammatory conditions, neuromuscular pathology, and pain management interventions. The fibrotic encapsulation of the spinal cord stimulator suggests that long-term neuromodulation devices may trigger persistent inflammatory responses that could potentially alter their therapeutic efficacy over time. Furthermore, the coexistence of critical illness myopathy, reflex sympathetic dystrophy, and PASH syndrome in this patient illustrates how systemic inflammatory processes can simultaneously affect multiple organ systems, creating a challenging clinical picture where neuromuscular deterioration, pain sensitization, and impaired wound healing form a self-perpetuating cycle. These findings highlight the need for comprehensive, multidisciplinary approaches to complex pain syndromes that address not only symptom management but also the underlying inflammatory and degenerative processes across neural, muscular, and cutaneous systems.