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Lumbar Sympathectomy

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Lumbar Sympathectomy

Neurosciences | Posted on 07/10/2020 by Dr. Amit Chakrabarty

In the human body, the sympathetic nervous system controls involuntary actions such as the heart rate, digestion, and breathing. While sympathetic nerves, that branch out from the spinal cord to the lower back (lumbar) region do not send pain signals to the brain, they start doing so in the case of malfunction. This results in painful sensations in the leg or foot, which can be treated with a lumbar sympathectomy.

Understanding sympathectomy

A sympathectomy is a procedure where a sympathetic nerve is cut or blocked to treat chronic conditions like severe sweating, excessive facial blushing, poor blood flow to the legs, chest pain, etc. This treats the symptoms by preventing signals from passing from the brain through the nerve. Depending on the part of the nerve that is treated, the procedure is called endoscopic thoracic sympathectomy or endoscopic lumbar sympathectomy.

What is a lumbar sympathectomy?

The lumbar sympathetic chain is a bunch of nerves situated in the lower back, which control blood supply to the legs. In a lumbar sympathectomy procedure, an injection (typically a local anaesthetic and steroid anti-inflammatory) is introduced to block the pain-inducing sympathetic nerves, thus increasing blood supply to the leg and reducing pain.

Why is it done?

Lumbar sympathectomy is performed in the following cases –

  • To reduce leg and foot pain caused by the poor blood supply
  • To treat excessive sweating of the feet
  • To heal leg and foot ulcers
  • To relieve leg and back pain caused by spinal canal stenosis

When an individual’s legs or feet are affected by the over-activity of sympathetic nerves in the lumbar region, the skin in the legs can appear blotchy or pale. Sometimes, there is also a loss of hair in the area. Pain associated with the sympathetic nerves is constant, coming and going in phases. It is often a stabbing or sharp pain that can also change with the seasons.

Unfortunately, this pain doesn’t respond too well to conservative treatments such as rest or oral painkillers like Ibuprofen and Paracetamol. Thus, a lumbar sympathectomy is the only viable option to treat the condition.

Lumbar sympathectomy – How is it done?

In lumbar sympathectomy, an injection is given to the group of sympathetic nerves that control the feet, legs, or lower back. This injection blocks pain signals from the brain, thus resulting in pain relief.

The patient is given an IV in the hand and a mild sedative. Then, the patient is placed on the stomach and a needle is guided to the site using a live X-ray. A local anaesthetic solution with or without steroids is injected close to the nerve. The entire procedure takes around 30 minutes. Most patients feel pain relief within 15 minutes of completion.

How effective is the procedure?

Some patients report pain relief immediately after the procedure. However, the pain can return a few hours later when the effect of the anaesthetic wears off. Longer-term pain relief typically happens in a couple of days, once the steroid starts its work. Usually, patients will require a series of injections to continue the pain relief.

What happens before the procedure?

Before the procedure, patients are advised to stop all blood thinning products and medications, except aspirin. If the patient is an insulin-dependent diabetic, they can take their insulin following the procedure.

Prior to the procedure, the patient must not eat, drink, it smokes.

Can complications develop?

As can happen with any procedure, some side effects may occur after a lumbar sympathectomy. Typically, these are minor and pose no danger. Sometimes, there is a slight chance of contracting an infection in the area where the needle is placed.

The sympathectomy injection can result in a drop in the patient’s blood pressure. Sometimes, this can last for a couple of weeks. There is a minuscule risk of damage to nearby structures like the bowel, kidneys, or blood vessels in the abdomen.

In men, a lumbar sympathectomy on both sides can sometimes result in sexual problems. Discuss this with your doctor before the procedure.

What happens after the procedure?

After the procedure, the patient’s blood pressure is checked and they are made to rest for an hour before they can leave. It is advisable to have someone to drive you home.

It is also advised to take it slow for some days before you can resume your usual activities.

Is lumbar sympathectomy right for me?

A lumbar sympathectomy is the right treatment for you if you are experiencing lower back or leg pain that does not respond to other treatments. You can discuss other treatment options with your doctor before you go ahead with this, who will give you up-to-date information about the likelihood of its success.