Korean J Pain.  2016 Apr;29(2):103-109. 10.3344/kjp.2016.29.2.103.

Clinical Identification of the Vertebral Level at Which the Lumbar Sympathetic Ganglia Aggregate

• An JW
• Koh JC
• Sun JM
• Park JY
• Choi JB
• Shin MJ
• Lee YW

• KMID: 2365352
• DOI: http://doi.org/10.3344/kjp.2016.29.2.103

Abstract

BACKGROUND
The location and the number of lumbar sympathetic ganglia (LSG) vary between individuals. The aim of this study was to determine the appropriate level for a lumbar sympathetic ganglion block (LSGB), corresponding to the level at which the LSG principally aggregate.
METHODS
Seventy-four consecutive subjects, including 31 women and 31 men, underwent LSGB either on the left (n = 31) or the right side (n = 43). The primary site of needle entry was randomly selected at the L3 or L4 vertebra. A total of less than 1 ml of radio opaque dye with 4% lidocaine was injected, taking caution not to traverse beyond the level of one vertebral body. The procedure was considered responsive when the skin temperature increased by more than 1℃ within 5 minutes.
RESULTS
The median responsive level was significantly different between the left (lower third of the L4 body) and right (lower margin of the L3 body) sides (P = 0.021). However, there was no significant difference in the values between men and women. The overall median responsive level was the upper third of the L4 body. The mean responsive level did not correlate with height or BMI. There were no complications on short-term follow-up.
CONCLUSIONS
Selection of the primary target in the left lower third of the L4 vertebral body and the right lower margin of the L3 vertebral body may reduce the number of needle insertions and the volume of agents used in conventional or neurolytic LSGB and radiofrequency thermocoagulation.

Keyword

Clinical identification; Lumbar; Neurolytic; Radiofrequency; Sympathetic ganglia; Vertebral level

MeSH Terms

Electrocoagulation
Female
Follow-Up Studies
Ganglia, Sympathetic*
Humans
Lidocaine
Male
Needles
Skin Temperature
Spine
Lidocaine

Figure

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  Fig. 1 Fluoroscopic view of LSGB. (A) Anteroposterior fluoroscopic view of the level of spread of the dye. (B) Lateral view of the level of spread of the dye. In this case, A and B demonstrate that the longitudinal dye spread is from point 5.5 to 7.5 on the numerical scale (see Fig. 2).

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  Fig. 2 The space between upper border of sacrum and upper border of L2 vertebral body were divided into 16 segments to allow numerical description of the dye spread.

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  Fig. 3 The mean responsive level in male and female patients. The boxes are expressed as the median (Q1−Q3).

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  Fig. 4 The mean responsive level in left- and right-sided LSGB. The boxes are expressed as the median (Q1−Q3).

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