Thirty year experience with predictive lumbar sympathectomy. Method for selection of patients

An office or bedside procedure to predict benefit from or contraindications to lumbar sympathectomy has been presented. Significant benefit and no instance of paradoxic gangrene occurred in an experience of more than 30 years with the test. This personal series of over 70 patients illustrates significant benefits, including healing of gangrenous digits, successful ray (transmetatarsal) amputation, and relief of ischemic rest pain in selected patients, even in the absence of femoral (groin) pulses. A criterion of an increase of 2 degrees or more in skin temperature of the ipsilateral great toe after lumbar sympathetic block at the approximate levels of the second, third, and fourth lumbar vertebrae has proved to be an adequate parameter or indication of subsequent benefit from surgical lumbar sympathectomy. A favorable response is predictable by the method described.