Is section of the sympathetic rami communicantes by laparoscopy in patients with refractory low back pain efficient?
OBJECTIVE
The objective of this prospective innovative treatment is to section the pain pathways carried by sympathetic lumbar rami communicantes to achieve lasting pain relief of refractory low back pain.


METHODS
From December 2005 to September 2008, nine patients were operated by bilateral section of rami communicantes for a refractory low back pain. As a diagnostic and predictive test, all patients had, before surgery, a local anaesthetic infiltration of the sympathetic trunk at L2 performed with computed tomography guidance. Surgery is indicated if the tests lead to a reduction in pain of at least 50 %. The procedure, using a retroperitoneal laparoscopic approach, consisted to identify the sympathetic trunk and to section all lumbar rami communicantes from L1 to L2.


RESULTS
No intraoperative complications were observed. The mean postoperative follow-up was 29 ± 15 months. At the last follow-up, only 22 % (2/9) patients had an improvement of their low back pain with this surgery but with a minimal effect (30 and 50 % reduction of pain). An improvement of quality of life was observed in 33 % (3/9) of cases. Due to persistent pain, four patients had a spinal cord stimulation after this surgery.


CONCLUSIONS
Section the pain pathways carried by sympathetic lumbar rami communicantes for refractory low back pain improved 22 % of patients at the last follow-up of 29 months.
Urology Clinic, CHU Hôtel Dieu, Nantes University Hospital Centre, 1 place Alexis Ricordeau, 44000 Nantes, France. jrigaud@chu-nantes.fr
Jérôme
J
Rigaud
Thibault
T
Riant
Jean-Jacques
JJ
Labat
Michel
M
Guerineau
Roger
R
Robert
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D017116:Low Back Pain / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000294:innervation*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D013127:Spinal Nerves / Q000601:surgery*; D013564:Sympathetic Nervous System / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome