Lumbar sympathectomy: a single needle technique.

A single-needle lumbar sympathectomy technique is described which uses the tip of the 12th rib as a marker to determine the appropriate position for the insertion of the needle. Radiological screening is used to control final placement at the body of L3 and to visualize spread of radio-opaque phenol in the correct prevertebral plane. Following sympathectomy, fore-foot temperatures increased by a mean of 3 degrees C and lower leg blood flow doubled, these being accompanied by significant increases in ankle pressure index and venous oxygen tensions in the affected foot. These physiological improvements brought about resolution of ischaemic foot pain in 70% of patients at follow up 1 month later. As these results were not significantly different from those obtained in patients having two-needle sympathectomy, blockade with a single needle under x-ray control is considered to be an effective technique for the performance of neurolytic sympathectomy.