Lumbar Sympathectomy: A Single Needle Technique

Abstract

A single-needle lumbar sympathectomy technique is described which uses the tip of the 12th rib as a marker to determine the appropriate position for the insertion of the needle. Radiological screening is used to control final placement at the body of L3 and to visualize spread of radio-opaque phenol in the correct prevertebral plane. Following sympathectomy, fore-foot temperatures increased by a mean of 3 degrees C and lower leg blood flow doubled, these being accompanied by significant increases in ankle pressure index and venous oxygen tensions in the affected foot. These physiological improvements brought about resolution of ischaemic foot pain in 70% of patients at follow up 1 month later. As these results were not significantly different from those obtained in patients having two-needle sympathectomy, blockade with a single needle under x-ray control is considered to be an effective technique for the performance of neurolytic sympathectomy.

Change in pulse transit time in the lower extremity after lumbar sympathetic ganglion block: an early indicator of successful block

“…Monitoring the changes in skin temperature is another method for evaluating sympathetic block. 3 , 7 , 20 , 21 Because body temperature is largely dependent on blood flow, sympatholysis could be measured in terms of the increase in temperature of the ipsilateral extremity after a sympathetic block. Skin temperature measurement is inexpensive and painless, so it has been commonly used to evaluate sympathetic blocks in most busy clinical settings.…”

Clinical Identification of the Vertebral Level at Which the Lumbar Sympathetic Ganglia Aggregate

“…In single-needle LSGBs with large volumes (>5 ml), which have been performed in an earlier era, the tip of the needle did not necessarily need to be close to the ganglion because the injected solution would sufficiently spread along the sympathetic chain [ 4 15 ]. However, with the injection of larger volumes, there is an increase in the frequency of complications, including motor weakness, genitofemoral neuritis, lumbar neuralgia, and somatic nerve blockade, especially when neurolytic agents are used [ 5 11 ].…”

Technique of computed tomography guided chemical lumbar sympathectomy for peripheral vascular disease-a study of its efficacy in the Indian population

“…75% of vascular surgical society members in UK and Ireland still continue to use lumbar chemical sympathectomy in their practice. [6][7][8] Many studies have documented the efficacy of CT guided lumbar sympathectomy in treating severe rest pain due to inoperable peripheral vascular disease. In a recent study by Florek R et al, 80% showed significant improvement at 3 months which correlated with our study.…”