Fluoroscopic Localization of L3 Sympathetic Ganglion Prior to Endoscopic Lumbar Sympathectomy

Abstract

Abstract Purpose: Plantar hyperhidrosis can cause a significant impact on an individual's quality of life. Surgical treatment of plantar hyperhidrosis involves blocking the lumbar sympathetic signals from reaching the plantar surface by placing a metal clip above the third lumbar ganglion. We hypothesize that by mapping the location of the third lumbar ganglion and correlating it with a fluoroscopic image of the lumbar spine will improve the level accuracy of lumbar sympathectomy. METHODS: Ten human cadavers were dissected to define the locations of lumbar sympathetic ganglia, and fluoroscopic images of lumbar spine were obtained. RESULTS: For the right L3 sympathetic ganglion most common locations corresponded with the upper 1/3 of the L3 vertebral body 36.4%, and the next most common location corresponded to the lower 1/3 of the L2 vertebral body 27.3%. The left L3 sympathetic ganglion the most common sites corresponded with the upper 1/3 of the L3 vertebral body 36.4% and the middle 1/3 of the L3 vertebral body 36.4%. CONCLUSION: The L3 ganglion is consistently found next to either L2 or L3 vertebrae.