The lumbar sympathetic. Anatomy and surgical implications.

The ganglionated lumbar sympathetic chains lie on the lateral aspects of the bodies of the lumbar vertebrae and not more laterally as in the thorax where the chain lies in relation to the heads and necks of the ribs. Lumbar ganglia vary in number. They are best numbered according to the spinal nerve to which the particular ganglion sends its postganglionic fibers, but, at operation, the surgeon is unable to obtain this kind of information. It is customary to mark the extent of resection by the application of a dura clip to the proximal and distal ends of the trunk. Roentgenographic visualization later can approximate the level of resection in relation to the vertebrae. Anomalies can lead to unsuccessful denervation of the lower extremities. These include extraganglionic connecting sympathetic nerve trunks, intermediate ganglia, and cross-over fibers connecting the right and left lumbar sympathetic trunks usually at the level of the fourth and fifth lumbar segments, but anatomically sometimes as high as the third and second. Specific complications of lumbar sympathectomy include failure of adequate denervation, brief paralytic ileus, hyperidrosis in parts of the body which remain normally innervated, sexual dysfunction, and post-sympathectomy neuralgia.