Lumbar Sympathetic Neurolysis: How to and When to Use?

Lumbar sympathectomy was historically a mainstay of treatment for arterial occlusive disease and other vasospastic disorders, before the development of contemporary arterial reconstructive procedures either by surgical or endovascular means. Today, percutaneous methods of sympathetic blockade are possible using chemical neurolytic or ablative modalities. Lumbar sympathetic neurolysis is generally reserved for those patients with ischemic rest pain in the setting of nonreconstructable arterial occlusive disease, although patients with complex regional pain syndrome, peripheral neuralgia, vasospastic disorders, and various other disease states such as plantar hyperhydrosis may also benefit. A working knowledge of procedural anatomy and physiology, accompanied by appropriate patient selection, serve to maximize procedural success and minimize complications, which although infrequent may cause significant morbidity. A review of technique with a focus on traditional fluoroscopy is described, with attention drawn to intraprocedural and immediate postprocedural findings, as well as discussion of expected outcomes.