RADIOFREQUENCY LUMBAR SYMPATHOLYSIS - THE EVOLUTION OF A TECHNIQUE FOR MANAGING SYMPATHETICALLY MAINTAINED PAIN

Background and Objectives. To develop lumbar radiofrequency sympatholy sis for the relief of pain in patients with neuropathic pain who had p reviously responded to sympathectomy or sympathetic blocks. Methods. T he technique described by Sluijter was modified to attempt to obtain l ong lasting pain relief in each patient. No one technique was universa lly applicable. The variations in technique are illustrated by the cas e reports. The basic technique that evolved is as follows: a 20-gauge 15-cm insulated needle with a 5-mm active tip was inserted in the dire ction of an x-ray beam (C arm). The initial target was slightly cephal ad to the middle of the L3 vertebra. Contrast medium was injected to c onfirm the location of the needle. The temperature of the tip of the n eedle was controlled at 80-degrees-C for 90 seconds. Results. Thirty-e ight procedures were performed on 20 patients. Reproduction of the pai n for which the sympatholysis was undertaken, induced dysesthesia, spr ead of dye, rapidity of temperature rise in the legs, and increase in pulse volume of the toes were useful guides to proper placement of the needle. Five patients continue to be pain free 5 months to 3 years af ter the last radiofrequency sympatholysis. Fifteen had temporary relie f or no relief at all. The procedure was temporarily complicated by an excessively hot, swollen foot, and postsympathectomy neuralgia in a f ew cases. Conclusions. A single technique of radiofrequency sympatholy sis does not appear to be applicable to all patients with reflex sympa thetic dystrophy or sympathetically maintained pain. Despite early suc cessful sympathetic block with radiofrequency, as confirmed by a warm foot, long lasting pain relief was difficult to obtain. The author con cludes that individualized patient management is necessary when consid ering radiofrequency sympatholysis in the treatment of patients with s ympathetically maintained pain.