Lumbar Sympathectomy
Introduction
The sympathetic nervous system is in charge of controlling the actions of the body that we aren’t consciously aware of, such as the heart rate, breathing or digestion. Typically, these sympathetic nerves do not send pain signals, but in certain conditions they can become ‘switched on,’ or spontaneously start sending pain signals to the brain. When this happens to the sympathetic nerves that are found branching out from the spinal cord in the lumbar, or lower back region, this can cause painful sensations in the leg or foot. In this case, a lumbar sympathectomy can be an effective treatment to relieve the pain.
Symptoms
When the legs or feet are affected by over activity of the sympathetic nerves of the lumbar region, the skin of the affected are may appear to be blotchy or pale, and there even may be a loss of hairs in the area. Pain associated with the sympathetic nerves is typically constant and can come and go in waves. It can be affected by hot or cold weather, so it can change with the seasons, and has been described by patients as being stabbing, sharp or shooting pain.
Unfortunately, pain caused by over activity of sympathetic nerves is resistant to conservative treatments such as rest or oral pain killers, from over the counter pain killers such as ibuprofen and paracetamol to stronger pain killers that are only available through a prescription. There is no test available to confirm the diagnosis, but a lumbar sympathectomy can be an effective diagnostic tool as well as an effective form of treatment.
The Procedure
A lumbar sympathectomy is an injection near the junction of sympathetic nerves that control the feet, legs or lower back. This injection works to block the pain signals from the brain, effectively relieving the pain. First, the patient is given an IV in the hand and administered a mild sedative. Then the patient is placed on his stomach and the procedure can begin.
A needle is guided to the appropriate site using fluoroscopy, or a live x-ray, to make sure that the injection is made in the right place. The site of the injection is cleaned and a local anaesthetic is administered before the needle is inserted. Once it is confirmed that the needle has found the right place, a solution of local anaesthetic, sometimes combined with an anti-inflammatory steroid, is injected at the junction of sympathetic nerves which controls the affected area. The solution washes over the sympathetic nerves and blocks the pain signals from being sent to the brain. This procedure generally takes less than twenty minutes.
After the procedure, most patients will feel relief from the pain within fifteen minutes. The patient will be observed by medical staff for up to two hours after the procedure and should be escorted home by a friend or family member. Patients shouldn’t operate machinery within twenty-four hours after the procedure.
