Lumbar sympathectomy

A lumbar sympathectomy is intended to block the nerves in the lower back. These control the blood supply to the legs and the procedure is to deal with problems there. These can include pain caused by bad blood supply to the legs or feet, to aid ulcers in either area to heal.

It can also be pain relief for problems caused by spinal canal problems. Excessive sweating of the feet may be treated by a lumbar sympathectomy.

As with a sympathectomy in general, a lumbar sympathectomy involves the permanent cutting or cauterisation of the sympathetic nerves. You will see some descriptions that say it can be done with an injection. That is, correctly, a nerve root block, not a sympathectomy.

The difference is that the nerve root block is a temporary treatment, a sympathectomy a permanent one.

A lumbar sympathectomy changes the body's management of blood supply to the legs. Therefore, problems that arise from a blood supply problem to the legs may be treated in this way.

These can include foot or leg ulcers that simply will not heal. Excessive sweating of the feet can have this cause, so can persistent pain in the legs or feet.

One of the effects is to increase blood supply to the skin of the legs, so a lumbar sympathectomy can be used to increase healing there.

Some of these are temporary problems, not permanent, so will more likely be treated with a nerve block.

A lumbar sympathectomy is surgery, under a general anaesthetic. Incisions will be made into the abdomen in order to gain access to the nerves around the spine.

These will then be cut or cauterised in order to permanently disable them. The work is done by arthroscopy, or keyhole surgery.

The operation itself will take one to two hours. The anaesthetic will require nil by mouth from the night before.

The incisions will take about a week to heal properly. It will be possible to return to work after this has happened.

Mobility is possible near immediately but heavy physical labour or exercise should be delayed for that week.

The anaesthetic will require its own recovery time. It is normal to stay in hospital overnight for this with return home the next day after the operation.

There are the usual risks associated with surgery, infection, post-operative bleeding, the anaesthetic itself.

Risks more specific to a lumbar sympathectomy are nerve damage to those nerves that are not meant to be affected.

All of these will be closely monitored.