Lumbar Sympatholysis

Excerpt

Lumbar sympathetic blocks that 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 and 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 fluoroscopy, chemical neurolysis, 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 techniques is provided for practitioners to help improve understanding and outcomes and minimize mortality and other adverse effects.

It is important to distinguish lumbar sympatholysis from 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, whereas the lumbar sympathetic block 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.