Lumbar Sympathetic Nerve Block Research Articles

A Case of Successful Treatment of a Diabetic Foot Burn with Lumbar Sympathetic Nerve Block

A Case of Successful Treatment of a Diabetic Foot Burn with Lumbar Sympathetic Nerve Block

Calf And Foot Injury- Crossfit

HISTORY: A 51-year-old female presented with three-year worsening left lower leg and foot pain. No injury at time of onset but was active with CrossFit five times weekly. Pain began on bottom of forefoot with radiation through the sole of foot to posterior calf and popliteal fossa. Pain described as 7-8/10 in intensity, constant, sharp/stabbing in nature, with burning sensation on the bottom of foot. Associated with weakness of the left ankle, foot drop requiring patient to wear an ankle-foot orthotic, swelling, and color changes with her foot turning blue/red intermittently. Pain was unrelieved with oral NSAIDS, steroids, and only temporary relief with topical anti-inflammatory gel, heat/ice, deep tissue massage, and dry-needling with physical therapy. PHYSICAL EXAMINATION: Examination revealed skin color changes with blue discoloration of left foot that was cool to touch. Tender to palpation maximally over left gastrocnemius muscle, Achilles tendon, sole and ball of foot; 0/5 strength with left ankle dorsiflexion/plantar flexion, ankle inversion/eversion or great toe extension. Sensation intact to light touch in L2-S2 dermatomes. Reflexes normal and symmetric bilaterally. DIFFERENTIAL DIAGNOSIS: 1.Peripheral nerve damage secondary to entrapment/compression 2.Vascular insufficiency 3.Complex regional pain syndrome TEST AND RESULTS: MRI without IV contrast of left tibia/fibula, foot, ankle: - Mild intramuscular edema within gastrocnemius and soleus, focal fatty atrophy adjacent to medial soleus muscle. Generalized subcutaneous edema throughout ankle. EMG: -No evidence of left lumbosacral radiculopathy, left lower limb mononeuropathy, or large fiber peripheral neuropathy US lower extremity Veins: - No DVT in left lower extremity Ankle brachial index: - Normal arterial Doppler study on the left leg during rest with normal PVR waveforms. NM bone scan: - No abnormal blood flow or blood pool uptake involving the left foot or ankle. Mild radiotracer uptake in left midfoot. FINAL/WORKING DIAGNOSIS: Complex regional pain syndrome TREATMENT/OUTCOMES: 1. Physical Therapy focused on strengthening exercises and desensitization techniques 2. Diclofenac topical gel applied up to four times daily 3. Gabapentin 600mg BID 4. Referral to Pain Medicine for lumbar sympathetic nerve block

Relationship between ventral lumbar disc protrusion and contrast medium leakage during sympathetic nerve block

Ventral disc protrusions have been neglected because they are asymptomatic. Lumbar sympathetic nerve block (LSNB) is one of the clinical choices for refractory low back pain treatment. Leakage of the contrast medium may occur and lead to complications, especially when using a neurolytic agent. In this study, we retrospectively reviewed the magnetic resonance images (MRIs) of 52 consecutive patients with refractory low back pain due to lumbar spinal canal stenosis who underwent LSNB, and graded ventral disc protrusion at the L1/2 to L5/S1 vertebral discs on a three-point scale (grade 0 = no protrusion, grade 1 = protrusion without migration, grade 2 = protrusion with migration). We also determined if there was leakage of contrast medium in LSNB. Ventral disc protrusion was observed in all patients, and 75 % (39/52) had grade 2 protrusion in the L1/2-L3/4 vertebral discs. Moreover, the incidence of contrast medium leakage was significantly higher at the vertebrae that had grade 2 protrusion than at those with less protrusion. We revealed a higher incidence of ventral disc protrusion of the lumbar vertebrae than previously reported, and that the incidence of leakage in LSNB increased when ventral disc protrusion was present. To avoid complications, attention should be paid to ventral disc protrusions before performing LSNB.

Anterior herniation of lumbar disc induces persistent visceral pain: discogenic visceral pain

Background Visceral pain is a common cause for seeking medical attention. Afferent fibers innervating viscera project to the central nervous system via sympathetic nerves. The lumbar sympathetic nerve trunk lies in front of the lumbar spine. Thus, it is possible for patients to suffer visceral pain originating from sympathetic nerve irritation induced by anterior herniation of the lumbar disc. This study aimed to evaluate lumbar discogenic visceral pain and its treatment. Methods Twelve consecutive patients with a median age of 56.4 years were enrolled for investigation between June 2012 and December 2012. These patients suffered from long-term abdominal pain unresponsive to current treatment options. Apart from obvious anterior herniation of the lumbar discs and high signal intensity anterior to the herniated disc on magnetic resonance imaging, no significant pathology was noted on gastroscopy, vascular ultrasound, or abdominal computed tomography (CT). To prove that their visceral pain originated from the anteriorly protruding disc, we evaluated whether pain was relieved by sympathetic block at the level of the anteriorly protruding disc. If the block was effective, CT-guided continuous lumbar sympathetic nerve block was finally performed. Results All patients were positive for pain relief by sympathetic block. Furthermore, the average Visual Analog Scale of visceral pain significantly improved after treatment in all patients (P <0.05). Up to 11/12 patients had satisfactory pain relief at 1 week after discharge, 8/12 at 4 weeks, 7/12 at 8 weeks, 6/12 at 12 weeks, and 5/12 at 24 weeks. Conclusions It is important to consider the possibility of discogenic visceral pain secondary to anterior herniation of the lumbar disc when forming a differential diagnosis for seemingly idiopathic abdominal pain. Continuous lumbar sympathetic nerve block is an effective and safe therapy for patients with discogenic visceral pain.

The efficacy of lumbar sympathetic nerve block for neurogenic intermittent claudication in lumbar spinal stenosis

Background: The symptoms of LSS include radicular symptoms (RS) and IMC. IMC is thought to be caused by circulatory disturbances in the cauda equina nerves and does not often resolve naturally. There are reports of increased cauda equina nerve blood flow in canine spinal stenosis models as a result of lumbar sympathetic resection. Thus, we believed that improvement of IMC in LSS may be achieved by performing a LSNB to produce a medium-term effect. Materials and Methods: Patients with LSS suffering from IMC in both legs were enrolled in this study. Those with IMC symptoms alone were classified as cauda equina-type (CE group), while those who also suffered from RS were classified as mixed-type (M group). LSNB was performed on both sides using a neurolysis in both groups. Evaluation was using the Zurich claudication questionnaire (ZCQ). Results: Twenty-six subjects were completed the six-month observation period. In contrast to the CE group who, throughout the observation period, experienced significant improvements in Symptom Severity (SS) and Physical Function (PF) scores compared with those before treatment, no such significant differences were observed in the M group throughout the observation period. In addition, a significant decrease in the SS scores of the CE group one-month after treatment and in the PF and Patient Satisfaction (PS) scores both one-month and two-months after treatment was observed in comparison with the M group. Conclusion: Our results show that LSNB for LSS is more effective in improving neurogenic intermittent claudication than radicular symptoms, and this suggests that LSNB could become an effective treatment for cauda equina-type lumbar spinal stenosis that is resistant to other conservative treatment.

The effectiveness of Lumbar sympathetic nerve block for neurogenic intermittent claudication in lumbar spinal stenosis

The effectiveness of Lumbar sympathetic nerve block for neurogenic intermittent claudication in lumbar spinal stenosis

Phantom bladder pain

Phantom bladder pain

Priapism Following a Lumbar Sympathetic Nerve Block

To understand an unusual complication of a common procedure. This article chronicles the side effect of a lumbar sympathetic nerve block (LSNB). Loyola University Medical Center Outpatient Chronic Pain Clinic. One. Our patient had several hours of priapism following a LSNB. A bilateral lumbar sympathetic nerve block can lead to unopposed parasympathetic penile stimulation and cause priapism.

腰痛に対する各種保存治療―私はこうしている ブロック療法―腰痛に対する腰部交感神経節ブロック―腰痛に対する腰部交感神経節ブロックの位置付け―

腰痛に対する各種保存治療―私はこうしている ブロック療法―腰痛に対する腰部交感神経節ブロック―腰痛に対する腰部交感神経節ブロックの位置付け―

Page kidney resulting from massive subcapsular hematoma Complication of lumbar sympathetic nerve block

The Page kidney is a recognized cause of hypertension. A massive subcapsular hematoma caused by a lumbar sympathetic nerve block resulted in a Page kidney. To our knowledge, this sequence has not been reported. Small hematomas may be treated conservatively, but massive subcapsular hematomas should be decompressed when the patient is clinically stable. Diagnostic features, therapeutic considerations, and pertinent references are discussed.

A lateral approach for lumbar sympathetic nerve block.

A lateral approach for lumbar sympathetic nerve block.

Traumatic vasospasm and its relationship to wounds of the lower extremities

1. 1. The theory is advanced that some degree of traumatic vasospasm is suffered in all cases of compound fracture or serious wounds of the lower extremities. 2. 2. This theory is based on the supposition that any force sufficient to damage severely the tissues or to fracture heavy bones is sufficient to disturb the blood vessels, directly or indirectly, by damaging the sympathetic nervous system and thus producing arterial spasms of varying degrees. 3. 3. Although the vasospasm passes off in due time, it is postulated that this period of diminished blood supply to the part gives the infecting organisms time to establish themselves. 4. 4. A lumbar sympathetic nerve block, to prevent the interim of diminished blood supply, is advocated as routine in the effective therapeusis of compound fractures and severe wounds of the lower extremities. 5. 5. Several cases of severe compound fracture in which the nerve block was used with highly satisfactory results are described.