Lumbar Sympatholysis

Excerpt

Lumbar sympathetic blocks to result in a sympathectomy have been described as an effective pain management treatment strategy for several causes of chronic pain since the early 1900s. The first reports of a lumbar sympathetic block technique, as well as sympatholysis, were initially documented in the 1920s. The conditions for which this treatment has been effectively implemented include lower extremity complex regional pain syndrome (CRPS, formally known as RSD or causalgia) as well as various painful conditions resulting in circulatory insufficiency in the lower extremity such as Buerger's disease, embolic occlusions, frostbite, vasospastic disease, and peripheral arterial disease. Other possible indications may include phantom limb pain, hyperhidrosis, and postherpetic neuralgia. Procedural techniques have evolved with the involvement of fluoroscopy, chemical neurolysis approaches, and radiofrequency thermocoagulation approaches.

Surgical procedures (although not performed as often) have also been documented. An overview of interventional procedural anatomy, physiology, indications, contraindications, complications, and interventional technique is provided for practitioners in order to help improve understanding and outcomes as well as to help minimize mortality and other adverse effects.

It is important to distinguish lumbar sympatholysis from a lumbar sympathetic block in that this procedure specifically seeks to accomplish a more long-term or permanent disruption of the sympathetic chain output to the lower extremity in comparison to the lumbar sympathetic block which typically utilizes only local anesthetics. However, the lumbar sympathetic block is often useful for diagnostic purposes on a potential candidate before performing more long-term treatment with lumbar sympatholysis.