Radiofrequency lumbar sympatholysis. The evolution of a technique for managing sympathetically maintained pain

To develop lumbar radiofrequency sympatholysis for the relief of pain in patients with neuropathic pain who had previously responded to sympathectomy or sympathetic blocks.

The technique described by Sluijter was modified to attempt to obtain long lasting pain relief in each patient. No one technique was universally applicable. The variations in technique are illustrated by the case reports. The basic technique that evolved is as follows: a 20-gauge 15-cm insulated needle with a 5-mm active tip was inserted in the direction of an x-ray beam (C arm). The initial target was slightly cephalad to the middle of the L3 vertebra. Contrast medium was injected to confirm the location of the needle. The temperature of the tip of the needle was controlled at 80 degrees C for 90 seconds.

Thirty-eight procedures were performed on 20 patients. Reproduction of the pain for which the sympatholysis was undertaken, induced dysesthesia, spread of dye, rapidity of temperature rise in the legs, and increase in pulse volume of the toes were useful guides to proper placement of the needle. Five patients continue to be pain free 5 months to 3 years after the last radiofrequency sympatholysis. Fifteen had temporary relief or no relief at all. The procedure was temporarily complicated by an excessively hot, swollen foot, and postsympathectomy neuralgia in a few cases.

A single technique of radiofrequency sympatholysis does not appear to be applicable to all patients with reflex sympathetic dystrophy or sympathetically maintained pain. Despite early successful sympathetic block with radiofrequency, as confirmed by a warm foot, long lasting pain relief was difficult to obtain. The author concludes that individualized patient management is necessary when considering radiofrequency sympatholysis in the treatment of patients with sympathetically maintained pain.