The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
권호 표지
DOI QR코드

DOI QR Code

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

  • An, Ji Won (Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine) ;
  • Koh, Jae Chul (Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine) ;
  • Sun, Jong Min (Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine) ;
  • Park, Ju Yeon (Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine) ;
  • Choi, Jong Bum (Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine) ;
  • Shin, Myung Ju (Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine) ;
  • Lee, Youn Woo (Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine)
  • Received : 2015.09.21
  • Accepted : 2016.01.12
  • Published : 2016.04.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The location and the number of lumbar sympathetic ganglia (LSG) vary between individuals. The aim of this study was to determine the appropriate level for a lumbar sympathetic ganglion block (LSGB), corresponding to the level at which the LSG principally aggregate. Methods: Seventy-four consecutive subjects, including 31 women and 31 men, underwent LSGB either on the left (n = 31) or the right side (n = 43). The primary site of needle entry was randomly selected at the L3 or L4 vertebra. A total of less than 1 ml of radio opaque dye with 4% lidocaine was injected, taking caution not to traverse beyond the level of one vertebral body. The procedure was considered responsive when the skin temperature increased by more than $1^{\circ}C$ within 5 minutes. Results: The median responsive level was significantly different between the left (lower third of the L4 body) and right (lower margin of the L3 body) sides (P = 0.021). However, there was no significant difference in the values between men and women. The overall median responsive level was the upper third of the L4 body. The mean responsive level did not correlate with height or BMI. There were no complications on short-term follow-up. Conclusions: Selection of the primary target in the left lower third of the L4 vertebral body and the right lower margin of the L3 vertebral body may reduce the number of needle insertions and the volume of agents used in conventional or neurolytic LSGB and radiofrequency thermocoagulation.

Keywords

References

  1. Boas RA. Sympathetic nerve blocks: in search of a role. Reg Anesth Pain Med 1998; 23: 292-305.
  2. Stanton-Hicks M. Complications of sympathetic blocks for extremity pain. Tech Reg Anesth Pain Manag 2007; 11: 148-51. https://doi.org/10.1053/j.trap.2007.05.007
  3. Datta S, Pai U. Paradiscal extraforaminal technique for lumbar sympathetic block: report of a proposed new technique utilizing a cadaver study. Pain Physician 2004; 7: 53-7.
  4. Hong JH, Oh MJ. Comparison of multilevel with single level injection during lumbar sympathetic ganglion block: efficacy of sympatholysis and incidence of psoas muscle injection. Korean J Pain 2010; 23: 131-6. https://doi.org/10.3344/kjp.2010.23.2.131
  5. Middleton WJ, Chan VW. Lumbar sympathetic block: a review of complications. Tech Reg Anesth Pain Manag 1998; 2: 137-46. https://doi.org/10.1016/S1084-208X(98)80023-2
  6. Kim WH, Kim SK, Lee CJ, Kim TH, Sim WS. Determination of adequate entry angle of lumbar sympathetic ganglion block in Korean. Korean J Pain 2010; 23: 11-7. https://doi.org/10.3344/kjp.2010.23.1.11
  7. Umeda S, Arai T, Hatano Y, Mori K, Hoshino K. Cadaver anatomic analysis of the best site for chemical lumbar sympathectomy. Anesth Analg 1987; 66: 643-6.
  8. Rocco AG, Palombi D, Raeke D. Anatomy of the lumbar sympathetic chain. Reg Anesth 1995; 20: 13-9.
  9. Stevens RA, Stotz A, Kao TC, Powar M, Burgess S, Kleinman B. The relative increase in skin temperature after stellate ganglion block is predictive of a complete sympathectomy of the hand. Reg Anesth Pain Med 1998; 23: 266-70.
  10. Kim HJ, Lee CO, Shin YS, Lee YW. Appropriate block level in neurolytic lumbar sympathetic ganglion block. J Korean Pain Soc 2001; 14: 199-206.
  11. Sayson SC, Ramamurthy S, Hoffman J. Incidence of genitofemoral nerve block during lumbar sympathetic block: comparison of two lumbar injection sites. Reg Anesth 1997; 22: 569-74.
  12. Kim YC, Bahk JH, Lee SC, Lee YW. Infrared thermographic imaging in the assessment of successful block on lumbar sympathetic ganglion. Yonsei Med J 2003; 44: 119-24. https://doi.org/10.3349/ymj.2003.44.1.119
  13. Tran KM, Frank SM, Raja SN, El-Rahmany HK, Kim LJ, Vu B. Lumbar sympathetic block for sympathetically maintained pain: changes in cutaneous temperatures and pain perception. Anesth Analg 2000; 90: 1396-401. https://doi.org/10.1097/00000539-200006000-00025
  14. Gofeld M, Faclier G. Radiofrequency denervation of the lumbar zygapophysial joints--targeting the best practice. Pain Med 2008; 9: 204-11. https://doi.org/10.1111/j.1526-4637.2007.00345.x
  15. Hatangdi VS, Boas RA. Lumbar sympathectomy: a single needle technique. Br J Anaesth 1985; 57: 285-9. https://doi.org/10.1093/bja/57.3.285
  16. Waldman SD. Atlas of interventional pain management. 3rd ed. Philadelphia (PA), WB Saunders. 2004, pp 1314-21.
  17. Feigl GC, Dreu M, Ulz H, Breschan C, Maier C, Likar R. Susceptibility of the genitofemoral and lateral femoral cutaneous nerves to complications from lumbar sympathetic blocks: is there a morphological reason? Br J Anaesth 2014; 112: 1098-104. https://doi.org/10.1093/bja/aet552
  18. Hong JH, Kim AR, Lee MY, Kim YC, Oh MJ. A prospective evaluation of psoas muscle and intravascular injection in lumbar sympathetic ganglion block. Anesth Analg 2010; 111: 802-7. https://doi.org/10.1213/ANE.0b013e3181e9eb35
  19. Koizuka S, Saito S, Obata H, Tobe M, Koyama Y, Takahashi A. Anatomic analysis of computed tomography images obtained during fluoroscopic computed tomography-guided percutaneous lumbar sympathectomy. J Anesth 2008; 22: 373-7. https://doi.org/10.1007/s00540-008-0663-x
  20. Kuzmarov IW, MacIsaac SG, Sioufi J, DeDomenico I. Iatrogenic ureteral injury secondary to lumbar sympathetic ganglion blockade. Urology 1980; 16: 617-9. https://doi.org/10.1016/0090-4295(80)90574-9
  21. Ryttov N, Boe S, Nielsen H, Jacobsen J. Necrosis of ureter as a complication to chemical lumbar sympathectomy. Report of a case. Acta Chir Scand 1981; 147: 79-80.
  22. Baxter AD, O'Kafo BA. Ejaculatory failure after chemical sympathectomy. Anesth Analg 1984; 63: 770-1.
  23. Chung YJ, Choi JB, Lee YW. Radiofrequency lumbar sympatholysis: comparison with neurolytic alcohol block. J Korean Pain Soc 2004; 17: 42-6. https://doi.org/10.3344/jkps.2004.17.1.42
  24. Koizuka S, Saito S, Masuoka S, Nakajima K, Koyama Y. Location of major vessels in prone-positioned patients undergoing percutaneous lumbar sympathectomy. Neuroradiology 2012; 54: 1127-31. https://doi.org/10.1007/s00234-012-1007-y
  25. Bateman DK, Millhouse PW, Shahi N, Kadam AB, Maltenfort MG, Koerner JD, et al. Anterior lumbar spine surgery: a systematic review and meta-analysis of associated complications. Spine J 2015; 15: 1118-32. https://doi.org/10.1016/j.spinee.2015.02.040
  26. Rocco AG. Radiofrequency lumbar sympatholysis. The evolution of a technique for managing sympathetically maintained pain. Reg Anesth 1995; 20: 3-12.
  27. Racz GB, Stanton-Hicks M. Lumbar and thoracic sympathetic radiofrequency lesioning in complex regional pain syndrome. Pain Pract 2002; 2: 250-6. https://doi.org/10.1046/j.1533-2500.2002.02032.x
  28. Kim SH, Moon DE, Park CM, Ryu KH, Seo KS, You SH. Thoracic spinal cord stimulation and radiofrequency thermocoagulation of lumbar sympathetic ganglion in a patient with complex regional pain syndrome in the lower extremity: a case report. Korean J Pain 2005; 18: 240-5. https://doi.org/10.3344/kjp.2005.18.2.240
  29. Derby R, Lee CH. The efficacy of a two needle electrode technique in percutaneous radiofrequency rhizotomy: an investigational laboratory study in an animal model. Pain Physician 2006; 9: 207-13.
  30. Anfinsen OG, Kongsgaard E, Foerster A, Amlie JP, Aass H. Bipolar radiofrequency catheter ablation creates confluent lesions at larger interelectrode spacing than does unipolar ablation from two electrodes in the porcine heart. Eur Heart J 1998; 19: 1075-84. https://doi.org/10.1053/euhj.1998.1015
  31. Lee JH, Kim DW, Sim WS. Lumbar sympathetic radiofrequency thermocoagulation using bipolar probe in the hyperhidrosis patient: a case report. Korean J Pain 2005; 18: 92-5. https://doi.org/10.3344/kjp.2005.18.1.92
  32. Boas RA. Sympathetic blocks in clinical practice. Int Anesthesiol Clin 1978; 16: 149-82. https://doi.org/10.1097/00004311-197801640-00008
  33. Nagpal A, Eckmann M, Small S, Stevens S. Onset of spontaneous lower extremity pain after lumbar sympathetic block. Pain Physician 2015; 18: E89-91.

Cited by

  1. Superior articular process cross-sectional area is a new sensitive parameter for the diagnosis of lumbar central canal spinal stenosis vol.13, pp.None, 2016, https://doi.org/10.2147/cia.s172355
  2. Optimal cut-off points of lumbar pedicle thickness as a morphological parameter to predict lumbar spinal stenosis syndrome: a retrospective study vol.11, pp.None, 2018, https://doi.org/10.2147/jpr.s168990
  3. Ultrasound lumbar sympathetic block: Out of plane approach with insulated stimulation needle - Case series of three patients vol.64, pp.2, 2016, https://doi.org/10.4103/ija.ija_686_19
  4. Correlation between paravertebral spread of injectate and clinical efficacy in lumbar transforaminal block vol.10, pp.None, 2020, https://doi.org/10.1038/s41598-020-68474-5
  5. Quantitative Analysis of Real-Time Infrared Thermography for the Assessment of Lumbar Sympathetic Blocks: A Preliminary Study vol.21, pp.11, 2016, https://doi.org/10.3390/s21113573