Lumbar sympathectomy for causalgia secondary to lumbar laminectomy

This study reviews 12 patients (15 limbs) who underwent lumbar sympathectomies (LS) (after a series of chemical sympathetic blocks) for causalgia following a lumbar laminectomy (LL). To our knowledge, using LS to treat causalgia after LL has only been reported once before in the English literature.

Patients were classified (Drucker) as Stage I, II, or III. Sympathetic block results were graded as excellent, fair, or poor. Early and late responses to LS were classified as complete relief, partial relief (patient satisfied or unsatisfied), or no relief.

The mean duration between LL and the first sympathetic block was 8.4 months, with a mean of 9.5 months to LS. There were no operative deaths; however, 13% of limbs (2/15) had transient postoperative sympathetic neuralgia. Eighty percent (12 limbs) had an early satisfactory outcome after LS, and 73% (11 limbs) had a late satisfactory outcome. Stage II patients were more likely to have satisfactory early and late outcomes (92% and 85%) than Stage III patients (0%, P<0.01). Limbs with an excellent response to sympathetic block were more likely to have satisfactory early and late surgical outcomes (11/11, 100%). The time among LL and sympathetic block and L was shorter in patients who had satisfactory early and late surgical outcomes (P<0.0001). A multivariate analysis demonstrated that the most important independent factor in determining early and late outcomes of sympathectomy was the time between LL and LS (P=0.01).

LS for causalgia following LL should be confined to Stage II patients who have had an excellent response to sympathetic block.