Risk of sympathectomy after anterior and lateral lumbar interbody fusion procedures

Abstract

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.

Cadaveric Evidence of Complete Transection of the Lumbar Sympathetic Trunk After Extreme Lateral Transpsoas Approach to the Lumbar Spine: A Word of Caution

“…Lumbar sympathetic dysfunction (SD), carrying multiple potential clinical presentations such as dislocation, dysesthesia, reduced perspiration, increase in skin temperature, and swelling of the lower limb, has been reported in 4% of patients undergoing lateral transpsoas approaches at T12-L5, though this is 15% lower than the rate of injury documented during anterior approaches at the same levels [15]. Additional possible complications include retrograde ejaculation due to injury to the sympathetic plexus (well known in the urology literature), which occurs more often during dissection of the anterior longitudinal ligament in anterior approaches [16].…”

Relation of lumbar sympathetic chain to the open corridor of retroperitoneal oblique approach to lumbar spine: an MRI study

“…Inadvertent injury to LSC during anterolateral approach to spinal column is a known complication which may be underdiagnosed [13,18]. Hrabalek et al [14] reported 28 cases of post-anterior or lateral lumbar interbody fusion with post-sympathectomy syndrome. Sixteen cases (57%) can only be diagnosed by skin thermography without any other sign or symptom.…”

“…Lumbar sympathetic chain (LSC) usually runs anterolateral to vertebral body and anterior to psoas muscle [9][10][11] which makes it a structure at risk of injury during this approach. Accidental lumbar sympathectomy during anterior and lateral lumbar interbody fusion had been reported and associates with post-sympathectomy neuralgia and decreased quality of life [12][13][14][15].…”

Non-neurological major complications of extreme lateral and related lumbar interbody fusion techniques

“…in 2015 retrospectively analyzed the risk of sympathectomy (utilizing thermography) performing anterior lumbar interbody fusion (ALIF) vs. XLIF procedures between the T12–L5 levels [ Table 1 ]. [ 4 ] They found that ALIF correlated with a 15% rate of sympathectomy versus the 4% encountered with XLIF.…”