title: Risk of sympathectomy after anterior and lateral lumbar interbody fusion procedures.
abstract: OBJECTIVE
  The aim of this study was to identify retrospectively, lumbar sympathectomy (SE) using thermography (TG) and to evaluate clinically, the severity of post-sympathectomy (post-SE) dysfunction after anterior and lateral lumbar interbody fusion procedures (ALIF, XLIF).
  
  
  METHODS
  Twenty eight patients with suspected SE were referred for TG to both legs. They completed our questionnaire on severity of difficulties after SE. We evaluated the ability of physical examinations to reveal the SE in contrast to TG and compared the symptoms (warmer leg and inhibited leg sweating) of SE with questionnaire responses as subjective measure and TG as objective measure.
  
  
  RESULTS
  SE was diagnosed in 0.5% after ALIF at L5/S1, in 15% after ALIF at Th12-L5 and in 4% after XLIF at T12-L5. SE severely reduced the quality of life in two cases. The ability to distinguish differences in leg temperature by palpation after SE was found in 32%. All physical examinations together were insufficient for reliably disclosing SE. Subjective symptoms of SE were often false positive and proven SE by TG was often a clinically false negative.
  
  
  CONCLUSIONS
  This is the first study to examine post-SE dysfunction objectivelya using TG after ALIF and XLIF, and the first to evaluate clinically, the severity of the post-SE syndrome. Before surgery we cannot foresee potentially poor SE results. For this reason, injury to the sympathetic chain during surgery must be avoided. The advantage of TG for identifying SE is its non-invasiveness and reliability.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic.
authors.forename: Lumir
authors.initials: L
authors.lastname: Hrabalek
authors.affiliation: Department of Dermatology and Venereology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc.
authors.forename: Jan
authors.initials: J
authors.lastname: Sternbersky
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc.
authors.forename: Milan
authors.initials: M
authors.lastname: Adamus
mesh_terms: D000328:Adult; D001831:Body Temperature / Q000502:physiology; D005260:Female; D006801:Humans; D007007:Hypohidrosis / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology*; D011788:Quality of Life; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013564:Sympathetic Nervous System / Q000293:injuries*; D013817:Thermography; D020196:Trauma, Nervous System / Q000209:etiology*
keywords: interbody fusion; lumbar spine; sympathectomy; thermography