ISPINE.ORG Forum - Sympathectomy

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Sympathectomy - Warm Leg?

Please note that I'm writing this from memory... there are things that I may have misunderstood. I write here to promote discussion and hopefully, hear from people who've experienced this or discussed with their doctors as well.

While observing Diane's surgery, Dr. Bertagnoli said that she has an anomaly in the routing of part of the sympathetic nerve chain. He would have to sever the nerve. It's not uncommon and is not a serious issue. Apparently, there is a 1/3 chance that she'll experience "warm leg". The "sympathectomy" might cause her right leg to have increased blood flow, making it warm and also making it sweat less.

Further discussion with Dr. Fenk-Mayer revealed that the sympathectomy is a procedure performed to deal with some sympathetic nervous system issues. People with warm leg may like it and wish that the colder, more sweaty leg (the normal one) was effected as well.

Diane is just over 24 hours post-op from her 2-level ADR surgery and is doing better than we could have ever imagined. No sign of warm leg yet.

A quick internet search yielded:

Quote:

From: http://www.popovic.com.au/surgery_spinal.html2

Sympathectomy
On the front and side of the lumbar spine are a pair of nerves called the sympathetic trunks. These do not supply any movement or feeling to the legs but do supply the skin of the legs, making the skin sweat and the blood vessels constrict. Blood vessel constriction of the skin makes the skin cool and pale. Therefore, cutting a sympathetic trunk (called a sympathectomy) results in a warm and dry leg. This occurs in a few percent of anterior lumbar spine operations and occurs usually on the left side because the dissection over the lumbar spine is from left to right in order to displace the major vessels to the right. Injury to a sympathetic trunk can sometimes result in abnormally excessive sweating in the left leg.

Quote:

From: http://www.spine-dr.com/site/surgery...lications.html

Fortunately, nerve injuries related to the exposure are rare, even with redo procedures. The ilio-femoral nerve lying anteriorly on the psoas muscle can be injured or irritated causing referred pain to the lower abdomen and inguinal area. This usually resolves on its own. The sympathetic chain can be cut, causing a warm leg, this affect is usually temporary and no treatment is necessary. Damage to the parasympathetics in the dissection of the iliac vessels can result in retrograde ejaculation in males. This fortunately is a rare complication, but all males undergoing anterior spinal surgery need a very informed consent on this problem. The dissection around the iliac vessels should be kept to a minimum, and the bovey should not be used to minimize this complication.

Anyone know about this?

Mark

2.5 days out... no sign of warm leg.

Is there a post op time frame

That this would occur or perhaps with increased ambulation/weight bearing?
Diane, glad everything is going status quo apparently!

Hi Mark, Anne Conser here. Glad to hear Diane is doing so well. What a trip!! Please give her my best and the same to you. My back is feeling well.
Take care and enjoy some sightseeing if you can....

After my l4 to l5 to s1 prodisc I developed a new strange feeling...Just before I went to the wash room (the got to go feeling), I would get a warm wet feeling on the inside of my left leg..it still happens and is really strange..I thought the wet feeling was just a feeling...but the other day I discovered that the left leg was indeed sweating..the right leg was dry?

I have mentioned it on this forum before but never got the answer I thought it diserved, until now....I am sane...cannt spell, but still sane.

Oh and I forgot to mention..it didnt happy right after the surgery..more like 3 or 4 months later...

Rob.... I'm glad you finally got an answer.

Diane still has no warm leg... dry leg.... wet leg.... all not present. However, she does have some swelling of the left ankle now. Per Bertagnoli... regulation of bloodflow responsible for other symptoms also may be involved in swelling.

We'll post more as we learn it.

Mark

I just want to link a related discussion.... (Blue fingers post here)

very-very-interesting

hmmm, right after surgery, oh within an 8hour period i was rushed into a CT-scan due to abnormal swelling in my legs and feet and my left leg was warmer than my right, my scan noted some issues with my illiac veins and sympathetic trunk on my left side, to this day i struggle with some swelling, not as bad and the warm leg...again never had any good answers to support my questions, or maybe didn't know what to ask, hmmmmmm
very-very interesting!