Lumbar sympathectomy can improve symptoms associated with ischaemia, vasculitis, diabetic neuropathy and hyperhidrosis affecting the lower extremities-a single-centre experience

Abstract

Background: Lumbar sympthectomy (LS) was traditionally performed for intermittent claudication but is now eclipsed by revascularisation for that indication. However, it retains a role in the management of critical limb ischaemia and other conditions causing lower limb pain with or without ischaemia. We report the role of LS in modern surgical practice when revascularisation and pain management options have been exhausted.

Methods: A medical chart review was performed on all patients who underwent LS in our unit from 2005 to 2016 (inclusive). Symptomatology, surgical indications and patient outcomes were reported.

Results: Twenty-seven cases were performed in total (21 unilateral, 3 bilateral). Underlying diagnoses were as follows: PAD [59.3% (n = 16)], hyperhidrosis [18.5% (n = 5)] and equal numbers of complex regional pain syndrome, diabetic neuropathy and vasculitis [7.4% (n = 2) each]. Overall, 85.2% (n = 23) had improvement or resolution of symptoms at 1 month and 70.3% (n = 19) had persistent improvement of symptoms at 1 year. Non-PAD patients had superior outcomes with 90.9% (n = 10) reporting improved symptomatology at 1 month and nearly three quarters [72.8% (n = 8)] maintaining this improvement at 1 year. Only four patients required subsequent major amputation, all in the severe PAD group.

Conclusion: Lumbar sympathectomy can improve symptoms associated with ischaemia, vasculitis, diabetic neuropathy and hyperhidrosis. Non-PAD patients have the greatest benefit.

Keywords: Hyperhidrosis; Ischaemia; Lumbar; Neuropathy; Sympathectomy; Vasculitis.