Abstract
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). 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. 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. 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.
Highlights
Lumbar interbody fusion is a common surgical technique for the treatment of intervertebral disc diseases of degenerative or traumatic etiology[1,2]
The ALIF group after anterolateral approach at levels T12-L5 consisted of 120 patients (53 women and 67 men), mean age 44 years and the XLIF group after lateral access at the same levels consisted of 101 patients (57 women and 44 men), mean age 51 years
Positive TG as a proof of SE was found in 23 patients: 1/210 (0.5%) in ALIF L5/S1, 18/120 (15%) in ALIF T12-L5, 4/101 (4%) in XLIF T12-L5
Summary
Lumbar interbody fusion is a common surgical technique for the treatment of intervertebral disc diseases of degenerative or traumatic etiology[1,2]. During anterior or anterolateral minimally invasive approaches (ALIF - Anterior Lumbar Interbody Fusion) and lateral transpsoatic minimally invasive access (XLIF - Extreme Lateral Interbody Fusion) to the lumbar spine, it is sometimes necessary to sacrifice the lumbar sympathetic chain to obtain wider access to the discs[3,4,5]. The result of lumbar sympathectomy (SE) is post-sympathectomy (post-SE) dysfunction and it is usually characterized by increase in skin temperature, reduced perspiration and, sometimes, by dysestesias, discoloration and swelling of the lower limb on the side of surgery[6,7,8]. Patients commonly complain of a cold lower extremity on the side contralateral to the approach as the affected side is warmer due to loss of sympathetic vasoconstriction. The reported incidence of sympathetic dysfunction after ALIF is from 1% to 43% and after XLIF 4% (ref.[7,10,11,12,13,14])
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