Anesthesia Department, Hospital Intermutual de Levante, Sant Antoni de Benaixeve, Valencia, Spain.
The Clinical Anatomy, Embryology, and Neuroscience Research Group (NEOMA), Unit of Human Anatomy, School of Medicine, University of Girona, Girona, Spain.
Clin Anat. 2023 Apr;36(3):360-371. doi: 10.1002/ca.23938. Epub 2022 Aug 9.
The lumbar sympathetic block is often used to treat complex regional pain syndrome, but it seems to have a high failure rate. This study seeks anatomical explanations for this apparent failure in order to refine our block procedure. Two simulated sympathetic trunk blocks were carried out on four fresh, cryopreserved unembalmed human cadavers under fluoroscopic control at the L2 vertebral body level, followed by two further simulated blocks at the L4 vertebral body level on the other side. Dye was injected, and the areas were dissected following a specific protocol. We then describe the anatomy and the spread of the dye compared to the spread of the contrast medium on fluoroscopy. The ganglia were differently located at different vertebral levels, and differed among the cadavers. Following this anatomical clarification, we now prefer to perform lumbar sympathetic blocks at the fourth lumbar vertebra level, using an extraforaminal approach at the caudal end of the vertebra, avoiding the anterolateral margin of the vertebral body at the midpoint.
腰椎交感神经阻滞常用于治疗复杂区域疼痛综合征，但似乎有很高的失败率。本研究旨在寻找这种明显失败的解剖学解释，以完善我们的阻滞程序。在透视控制下，在 L2 椎体水平对四个新鲜冷冻未防腐的人体尸体进行了两次模拟交感干阻滞，然后在对侧 L4 椎体水平进行了另外两次模拟阻滞。注射染料后，根据特定方案解剖和分离区域。然后我们描述了解剖结构和染料的扩散与透视下造影剂的扩散的比较。神经节在不同的椎体水平位置不同，并且在不同的尸体之间也有所不同。在明确了解剖结构后，我们现在更喜欢在第四腰椎水平进行腰椎交感神经阻滞，在椎体的尾端采用椎间孔外途径，避开椎体中点的前外侧缘。
