title: Approach-related lesions of the sympathetic chain in anterior correction and instrumentation of idiopathic scoliosis.
abstract: During anterior scoliosis instrumentation with a dual-rod system, the vertebrae are dissected anterolaterally. After surgery, some patients report a change in temperature perception and perspiration in the lower extremities. Sympathetic lesions might be an explanation for this. The aim of this clinical study was to investigate sympathetic function after anterior scoliosis instrumentation. A total of 24 female patients with idiopathic scoliosis (mean age at follow-up, 23.8 years) who had undergone anterior instrumentation on average 6.6 years earlier were included. Due to the suspected relevance of the sympathetic L2 ganglion, two groups were created: a T12 group, in which instrumentation down to T12 was carried out (n = 12), and an L3 group, in which instrumentation down to L3 was done (n = 12). Sympathetic function was assessed by measuring skin temperature at the back of the foot, a plantar ninhydrin sweat test and sympathetic skin responses (SSRs) following electrical stimulation. The side on which the surgical approach was carried out was compared with the contralateral, control side. Health-related quality of life was investigated using the Scoliosis Research Society SRS-22 patient questionnaire. In the T12 group, mean temperatures of 29.6 degrees C on the side of the approach versus 29.5 degrees C on the control side were measured (P > 0.05); in the L3 group, the mean temperatures were 33.2 degrees C on the approach side versus 30.5 degrees C on the control side (P = 0.001). A significant difference between the T12 group and the L3 group (P < 0.001) was observed on the approach side, but not on the control side (P = 0.15). The ninhydrin sweat test showed reduced perspiration in 11 of 12 patients in the L3 group on the approach side in comparison with the control side (P = 0.002). In the T12 group, no significant differences were noted between the left and right feet. SSRs differed significantly between the two groups (P = 0.005). They were detected in all nine analyzable patients in the T12 group on both sides. In the L3 group, they were found on the approach side only in 4 of 11 analyzable patients versus 11 patients on the control side. The results of the SRS-22 questionnaire did not show any significant differences between the two groups. In conclusion, anterior scoliosis instrumentation with a dual-rod system including vertebrae down to L3 regularly leads to lesions in the sympathetic trunk. These are detectable with an increase in temperature, reduced perspiration and reduced SSRs. The caudal level of instrumentation (T12 vs. L3) has an impact on the extent of impairment, supporting the suspected importance of the L2 ganglion. The clinical outcome does not seem to be significantly limited by sympathetic trunk lesions.
authors.affiliation: Department of Orthopedics and Tumor Orthopedics, Münster University Hospital, Albert-Schweitzer-Strasse 33, 48149 Münster, Germany. dr.tobias.schulte@web.de
authors.forename: Tobias L
authors.initials: TL
authors.lastname: Schulte
authors.forename: Bastian
authors.initials: B
authors.lastname: Mester
authors.forename: Denise
authors.initials: D
authors.lastname: Oberdiek
authors.forename: Nani
authors.initials: N
authors.lastname: Osada
authors.forename: Ulf
authors.initials: U
authors.lastname: Liljenqvist
authors.forename: Timm J
authors.initials: TJ
authors.lastname: Filler
authors.forename: Martin
authors.initials: M
authors.lastname: Marziniak
authors.forename: Viola
authors.initials: V
authors.lastname: Bullmann
mesh_terms: D000293:Adolescent; D000328:Adult; D001342:Autonomic Nervous System Diseases / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects*; D012600:Scoliosis / Q000601:surgery*; D012881:Skin Temperature / Q000502:physiology; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013126:Spinal Nerve Roots / Q000293:injuries*; D013546:Sweating / Q000502:physiology; D055815:Young Adult