The outcome of percutaneous computed tomography-guided chemical lumbar sympathectomy for patients with causalgia after lumbar discectomy.
BACKGROUND
Coldness, numbness, or causalgia usually affects the lower limbs in patients after back surgeries. The treatment of causalgia is still the source of continuing debate. We treated patients presenting with causalgia secondary to LD with CT-guided CLS and determined the therapeutic outcome at long-term follow-up.


METHODS
From January 2002 to December 2002, a total of 15 patients (16 limbs) with causalgia after LD underwent the percutaneous CT-guided CLS. There were 7 male patients and 8 female patients, with an average age of 49.1 years. A total of 14 patients underwent unilateral procedures, and 1 patient underwent staged bilateral procedures. We followed up our patients for at least 24 months (24-36 months).


RESULTS
There were 13 patients (14 limbs) diagnosed as Drucker stage I and 2 patients as stage II. There were 88% (14 limbs) that had an early satisfactory outcome after CLS and 75% (12 limbs) that had a late satisfactory outcome (more than 24 months after CLS). Stage I patients had more satisfying early and late outcome than stage II patients (P= .014 and P= .039, respectively). Female patients were more likely to have satisfactory late outcome than male patients (P= .034). There was no operative mortality. A patient had a complication of genitofemoral neuralgia, which had recovered in a month.


CONCLUSIONS
We concluded that the percutaneous CT-guided CLS is an easy, safe, and reproducible technique, and it carries long-term benefit to patients with pain after LD presenting with causalgia, especially for patients with Drucker stage I and female patients.
Lee
Kung-Shing
KS
Division of Neurosurgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Su
Yu-Feng
YF
Lieu
Ann-Shung
AS
Chuang
Chin-Lin
CL
Hwang
Shiuh-Lin
SL
Howng
Shen-Long
SL
Lin
Chih-Lung
CL
D000328:Adult; D002422:Causalgia / Q000209:etiology* / Q000628:therapy*; D017586:Diskectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013563:Sympathectomy, Chemical / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome