Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2015, 159(2):318-326 | DOI: 10.5507/bp.2013.083

Risk of sympathectomy after anterior and lateral lumbar interbody fusion procedures

Lumir Hrabaleka, Jan Sternberskyb, Milan Adamusc
a Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
b Department of Dermatology and Venereology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc
c Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc

Aim: The aim of this study was to identify retrospectively, lumbar sympathectomy (SE) using thermography (TG) and to evaluate clinically, the severity of post-sympathectomy (post-SE) dysfunction after anterior and lateral lumbar interbody fusion procedures (ALIF, XLIF).

Methods: Twenty eight patients with suspected SE were referred for TG to both legs. They completed our questionnaire on severity of difficulties after SE. We evaluated the ability of physical examinations to reveal the SE in contrast to TG and compared the symptoms (warmer leg and inhibited leg sweating) of SE with questionnaire responses as subjective measure and TG as objective measure.

Results: SE was diagnosed in 0.5% after ALIF at L5/S1, in 15% after ALIF at Th12-L5 and in 4% after XLIF at T12-L5. SE severely reduced the quality of life in two cases. The ability to distinguish differences in leg temperature by palpation after SE was found in 32%. All physical examinations together were insufficient for reliably disclosing SE. Subjective symptoms of SE were often false positive and proven SE by TG was often a clinically false negative.

Conclusion: This is the first study to examine post-SE dysfunction objectivelya using TG after ALIF and XLIF, and the first to evaluate clinically, the severity of the post-SE syndrome. Before surgery we cannot foresee potentially poor SE results. For this reason, injury to the sympathetic chain during surgery must be avoided. The advantage of TG for identifying SE is its non-invasiveness and reliability.

Keywords: lumbar spine, sympathectomy, thermography, interbody fusion

Received: May 16, 2013; Accepted: November 6, 2013; Prepublished online: November 21, 2013; Published: June 28, 2015  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Hrabalek, L., Sternbersky, J., & Adamus, M. (2015). Risk of sympathectomy after anterior and lateral lumbar interbody fusion procedures. Biomedical papers, 159(2), 318-326. doi: 10.5507/bp.2013.083
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Crock HV. Anterior lumbar interbody fusion: indications for its use and notes on surgical technique. Clin Orthop 1982;165:157-63. Go to original source...
    2. Zdeblick TA, David SM. A prospective comparison of surgical approach for anterior L4-L5 fusion. Spine 2000;25:2682-7. Go to original source... Go to PubMed...
    3. Bergey DL, Villavicencio AT, Goldstein T, Regan JJ. Endoscopic lateral transpsoas approach to the lumbar spine.Spine 2004;29:1681-8. Go to original source... Go to PubMed...
    4. Ozgur BM, Aryan HE, Pimenta L, Tailor WR. Extreme lateral interbody fusion (XLIF): a surgical technique for anterior lumbar interbody fusion.Spine J 2006;6:435-43. Go to original source... Go to PubMed...
    5. Pimenta L. Lateral endoscopic transpsoas retroperitoneal approach for lumbar spine surgery. Paper presentation at the VIII. Brazilian Spine Society Meeting 2001. Belo Horizonte, Minas Gerais, Brazil.
    6. Kang BU, Choi WC, Lee SH, Jeon SH, Park JD, Maeng DH, Choi YG. An analysis of general surgery-related complications in a series of 412 minilaparotomic anterior lumbosacral procedures. J Neurosurg Spine 2009;10(1):60-5. Go to original source... Go to PubMed...
    7. Rajaraman V, Vingan R, Roth P, Heary RF, Conklin L, Jacobs GB. Visceral and vascular complications resulting from anterior lumbar interbody fusion. J Neurosurg (Spine 1) 1999;91:60-4. Go to original source...
    8. Schulte TL, Adolphs B, Oberdiek D, Osada N, Liljenqvist U, Filler TJ, Marziniak M, Bullmann V. Approach-related lesions of the sympathetic chain in anterior correction and instrumentation of idiopathic scoliosis. Eur Spine J 2010;19:1558-68. Go to original source... Go to PubMed...
    9. Kramis RC, Roberts WJ, Gillette RG. Post-sympathectomy neuralgia: hypotheses on peripheral and central neuronal mechanisms. Pain 1996;64(1):1-9. Go to original source... Go to PubMed...
    10. Carragee EJ, Mitsunaga KA, Hurwitz EL, Scuderi GJ. Retrograde ejaculation after anterior lumbar interbody fusion using rhBMP-2: a cohort controlled study. Spine J 2011;11:511-6. Go to original source... Go to PubMed...
    11. Faciszewski T, Winter RB, Lonstein JE, Denis F, Johnson L. The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. Spine 1995;20:1592-9. Go to original source... Go to PubMed...
    12. Hrabálek L, Adamus M, Wanek T, Macháč J, Tuček P. Surgical complications of the anterior approach to the L5/S1 intervertebral disc. Biomedical Papers 2012;156(4):354-8. Go to original source... Go to PubMed...
    13. Saraph V, Lerch C, Walochnik N, Bach CM, Krismer M, Wimmer C. Comparison of conventional versus minimally invasive extraperitoneal approach for anterior lumbar interbody fusion. Eur Spine J 2004;13:425-31. Go to original source... Go to PubMed...
    14. Tiusanen H, Seitsalo S, Osterman K, Soini J. Anterior interbody lumbar fusion in severe low back pain. Clin Orthop Relat Res 1996;324:153-63. Go to original source... Go to PubMed...
    15. Ammer K. The Glamorgan Protocol for recording and evaluation of thermal images of the human body. Thermology International 2008;18:125-44.
    16. Ammer K. Standard Procedures for Infrared Imaging in Medicine 10/2012; ISBN: 978-1-4398-7249-9 In: Medical Infrared Imaging. Principles and Practice, Chapter: 32, Publisher: CRC Press, Taylor & Francis Group, pp.32.1-32.14. Go to original source...
    17. Ammer K. Need for Standardisation of Measurements in Thermal Imaging In: Wiecek B (ed) Thermography and Lasers in Medicine. Akademickie Centrum Graficzno-Marketigowe Lodart S.A, Lodz 2003, pp. 13-18.
    18. Uematsu S, Jankel WR, Edwin DH, Kim W, Kozikowski J, Rosenbaum A, Long DM. Quantification of thermal asymmetry. Part 2: application in low-back pain and sciatica. J Neurosurg 1988;69(4):556-61. Go to original source... Go to PubMed...
    19. Furlan AD, Mailis A, Papagapiou M. Are we paying a high price for surgical sympathectomy? A systematic literature review of late complications. J Pain 2000;1:245-57. Go to original source... Go to PubMed...
    20. Merskey H, Bogduk N. Classification of Chronic Pain: Descriptions of Chronic Pain Syndrome and definition of Pain Terms. 2nd ed. Seattle: IASP Press. 1994.
    21. Mizuno S, Takebayashi T, Kirita T, Tanimoto K, Tohse N, Yamashita T. The effects of the sympathetic nerves on lumbar radicular pain. J Bone Joint Surg (Br) 2007;89-B:1666-72. Go to original source...
    22. Rieger R, Pedevilla S. Retroperitoneoscopic lumbar sympathectomy for the treatment of plantar hyperhidrosis: technique and preliminary findings. Surg Endosc 2007;21:129-35. Go to original source... Go to PubMed...
    23. Buche M, Randour P, Mayne A, Joucken K, Schoevaerdts JC. Neuralgia following lumbar sympathectomy. AnnVasc Surg 1988;2:279-81. Go to original source... Go to PubMed...
    24. Raskin NH, Levinson SA, Hoffmann PM, Pickett JBE, Fields HL. Postsympathectomy neuralgia: amelioration with Diphenylhydantoin and Carbamazepine. Am J Surg 1974;128:75-8. Go to original source... Go to PubMed...
    25. Rieger R, Laureiro MP, Pedevilla S, Oliveira RA. Endoscopic lumbar sympathectomy following thoracic sympathectomy in patients with palmoplantar hyperhidrosis. World J Surg 2011;35:49-53. Go to original source... Go to PubMed...
    26. Mockus MB, Rutherford RB, Rosales C, Pearce WH. Sympathectomy for causalgia. Patient selection and long-term results. Arch Surg 1987;122:668-72. Go to original source... Go to PubMed...
    27. Lacroix H, Vander Velpen G, Penninckx F, Nevelsteen A, Suy R. Technique and early results of videoscopic lumbar sympathectomy. Acta Chir Belg 1996;96:11-4. Go to PubMed...
    28. Bossut DF, Shea VK, Perl ER. Sympathectomy induces adrenergic excitability of cutaneous C-fiber nociceptors. J Neurophysiol 1996;75:514-7. Go to original source... Go to PubMed...
    29. Mayer HM, Wiechert K. Microsurgical anterior approaches to the lumbar spine for interbody fusion and total disc replacement. Neurosurgery 2002;51(Suppl 5):S159-65. Go to original source... Go to PubMed...
    30. 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. Go to original source... Go to PubMed...
    31. Murata Y, Takahashi K, Yamagata M, Takahashi Y, Shimada Y, Moriya H. Variations in the number and position of human lumbar sympathetic ganglia and rami communicantes. Clin Anat 2003;16:108-13. Go to original source... Go to PubMed...
    32. Feigl GC, Kastner M, Ulz H, Breschan C, Dreu M, Likar R. Topography of the lumbar sympathetic trunk in normal lumbar spines and spines with spondylophytes. British Journal of Anaesthesia 2011;106:260-5. Go to original source... Go to PubMed...
    33. Murata K, Omokawa S, Kobata Y, Tanaka Y, Yajima H, Tamai S. Long-term follow-up of periarterial sympathectomy for chronic digital ischaemia. J Hand Surg Eur Vol October 2012; 37:788-93. Go to original source... Go to PubMed...
    34. Tsai JC, Lim KB, Lin SY, Kao MC. Thermographic study of palmar and facial skin temperature of hyperhidrosis in patients before and after thoracic sympathectomy. J Formos Med Assoc 2000;99:466-71. Go to PubMed...
    35. Gabrhelík T, Michálek P, Pieran M, Adamus M, Berta E, Dobešová J, Marková K. Efektivita radiofrekvenční horní hrudní sympatektomie v léčbě Raynaudova fenoménu kontrolovaná termografií - pilotní studie. Bolest 2007;10(2):95-100.
    36. Friedman MS. The use of thermography in sympathetically maintained pain. Iowa Orthop J 1994;14:141-7. Go to PubMed...
    37. Chuang TY, Yen YS, Chiu JW, Chan RC, Chiang SC, Hsiao MP, Lee LS. Intraoperative monitoring of skin temperature changes of hands before, during and after endoscopic thoracic sympathectomy: using infrared thermograph and thermometer for measurement. Arch Phys Med Rehabil 1997;78:85-8. Go to original source... Go to PubMed...
    38. Vardasca R, Ring E F J, Plassmann P, Jones C D. Thermal symmetry of the upper and lower extermities in healthy subjects. Thermology International 2012; 22(2-22):53-60.

    Return to the content