In ankylosing spondylitis (AS), the axial skeleton, peripheral joints, and extra-articular structures are also frequently involved. Cutaneous lesions and vasculitis is extremely rare. Lumbar sympathectomy has a definite role in patients with painful cutaneous vasculitis and ischemic leg ulcer, especially those refractory to medical management. Despite the relatively small percentage of patients suffering from chronic leg ulcer, it has a significant impact on the patient's quality of life. A 44-year-old male AS patient with low backache (LBA) of 15 years and bilateral leg pain came to us. But in the past 2 years, severity of pain worsened resulting in infection and ulcer of dorsum of both feet. Examination confirmed multiple ulcers along with sensory loss on the dorsum of foot bilaterally. Not only he was refractory to conventional medical management, but he also had developed various side effects. Our results of diagnostic left lumbar sympathetic block (LSB) turned out to be positive. Next day, radiofrequency ablation (RFA) of lumbar sympathetic chain bilaterally at L2, L3, and L5 was done, and the patient was discharged pain free. At the 3-month review, the leg ulcers had healed, and the patient was pain free. So here, we discuss about the possible mechanisms and the role of LSB in vasculitic leg ulcers.
The various methods available for neurolysis include surgical ablation, chemical ablation, thermal ablation, cryoablation, and mechanical compression. Cryoneurolysis is the direct application of low temperature to ablate nerves to provide pain relief. The cryoprobe consists of a hollow tube with a smaller inner tube. Pressurized gas travels down the inner tube and is released into the larger outer tube through a very fine aperture that allows the gas to rapidly expand into the distal tip. This extracts heat from the tip of the probe resulting in extremely low temperatures at the tip itself forming an ice ball. The severities of cryolesion are dependent on the cryotemperatures. The cryo technology has been used in many other specialities. The sophisticated architecture of the probe was the real limiting factor in manufacturing extremely narrow gauge probes till very recently. The absence of nerve injury beyond second degree makes cryoneurolysis extremely safe weapon. In case of any inadvertent motor damage during cryoneurolysis the fibres recovers completely within a short span where as the pain fibres are ablated for a longer period. Apart from the above, still more facts like minimal procedural pain, immediate onset of action and versatile utility in chronic pain anywhere in the body make it a perfect choice for the future of neurolysis.
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