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Surgical and Radiologic Anatomy

, Volume 35, Issue 2, pp 99–106 | Cite as

The lumbar sympathetic trunk: its visibility and distance to two anatomical landmarks

  • Georg C. FeiglEmail author
  • Manuel Kastner
  • Heimo Ulz
  • Christian Breschan
  • Thomas Pixner
  • Manuel Dreu
  • Heinz W. Umschaden
  • Rudolf Likar
Original Article

Abstract

Objective

The lumbar sympathetic trunk’s (LST) distance to two anatomical landmarks, the costal process and medial margin of the psoas muscle, was assessed due to its use as landmarks for lumbar sympathetic blocks: the costal process for fluoroscopic guided techniques and the psoas major for CT- and MRI-guided techniques. Based on the measurements, we evaluate the trunk’s visibility in MR and CT images for accurate positioning of the needle.

Methods

A total of 54 cadavers embalmed with Thiel’s method were investigated. The LST’s distances to the psoas major’s medial margin and to the base of the lumbar vertebrae’s costal process were measured on the levels L2/3, L3/4 and L4/5. The measurements were compared to MR and CT images of 20 anonymous patients to identify the LST.

Results

LST’s mean distance to the psoas major was 0.3 mm at L2/3, 3.1 mm at L3/4 and 4.6 mm at L4/5. The mean distance to the costal process was 31 mm at L2/3, 34 mm at L3/4 and 32.6 mm at L4/5. In both MR and CT imaging, a structure could be determined as the LST correlating to the measurements with decreasing possible identification from cephalad to caudad levels.

Conclusions

The costal process is a usable landmark for fluoroscopic guidance and the psoas major for CT- and MRI-guided techniques. The LST is clearly visible in MR and CT images, which gives both techniques a decisive advantage over fluoroscopy concerning the block of the LST due to a visible target.

Keywords

Anatomy CT Lumbar sympathetic trunk MRI Sympathetic block 

Notes

Acknowledgments

We would like to thank Miss Tanya Ridout for her invaluable preparation of the manuscript.

Conflict of interest

No conflict of interest has been declared.

References

  1. 1.
    Anderhuber F, Brehmer A (2003) Spatium retroperitoneale. In: Fanghänel, Pera, Anderhuber, Nitsch (eds) Waldeyer: Anatomie des Menschen, 17th edn. deGruyter Berlin, New York, p 1024Google Scholar
  2. 2.
    Berry MM, Standring SM, Bannister LH (1995) Autonomic nervous system. In: Williams PL (ed) Gray’s anatomy, 38th edn. Churchill Livingstone, New York/Edinburgh, London, pp 1304–1305Google Scholar
  3. 3.
    Bonica JJ (1954) Lumbar sympathetic ganglia. In: Bonica JJ (ed) The management of pain. Lea & Febiger, Philadelphia, pp 441–442Google Scholar
  4. 4.
    Clara M (1953) Der Bauchteil des Sympathicus. In: Clara M (ed) Das Nervensystem des Menschen, 2nd edn. Johann Ambrosius Barth, Leipzig, p 236Google Scholar
  5. 5.
    Cousins MJ, Reeve TS, Glynn CJ, Walsh JA, Cherry DA (1979) Neurolytic lumbar sympathetic blockade: duration of denervation and relief of rest pain. Anaesth Intensiv Care 7:121–135Google Scholar
  6. 6.
    Delmas A (1970) Système végétatif abdominal. In: Rouvière H (ed) Tronc. 10th edn, vol. 2, Masson & Co, Paris, p 243Google Scholar
  7. 7.
    Feigl GC, Kastner M, Ulz H, Breschan C, Dreu M, Likar R (2011) Some important facts on the topography of the lumbar sympathetic trunk in normal lumbar spines and spines with spondylophytes. Br J Anaesth 106(2):260–265PubMedCrossRefGoogle Scholar
  8. 8.
    Hollinshead WH (1961) The sympathetic system in the abdomen. In: Hoeber PB (ed) Anatomy for surgeons, vol 2. Harper & Brothers, pp 611–617Google Scholar
  9. 9.
    König CW, Schott AG, Pereira PL, Trübenbach J, Schneider W, Claussen CD, Duda AH (2002) MR-guided lumbar sympathicolysis. Eur Radiol 12:1388–1393PubMedCrossRefGoogle Scholar
  10. 10.
    Leonhardt H, Zilles K (1988) Retroperitonealraum. In: Lehonardt H, Tillmann B, Zilles K (eds) Rauber/Kopsch. Anatomie des Menschen, Vol 4: Topographie der Organsysteme, Systematik der peripheren Leitungsbahnen. Thieme Stuttgart, New York, p 304Google Scholar
  11. 11.
    Perlow S, Vehe KL (1935) Variations in the gross anatomy of the stellate and lumbar sympathetic ganglia. Am J Surg 30(3):454–458CrossRefGoogle Scholar
  12. 12.
    Pick J (1970) The sympathetic denervation of the lower extremity. In: Pick J (ed) The autonomic nervous system. Lippincott Company, Philadelphia, Toronto, pp 418–422Google Scholar
  13. 13.
    Redman DR, Robinson DRO, Al-Kutobi MA (1986) Computerized tomography guided lumbar sympathectomy. Anaesthesia 41:39–41PubMedCrossRefGoogle Scholar
  14. 14.
    Rocco AG, Palombi D, Raeke D (1995) Anatomy of the lumbar sympathetic chain. Reg Anesth 20(1):13–19PubMedGoogle Scholar
  15. 15.
    Schmid MR, Kissling RO, Curt A, Jaschko G, Hodler J (2006) Sympathetic skin response: monitoring of CT-guided lumbar sympathetic blocks. Radiology 241(2):595–602PubMedCrossRefGoogle Scholar
  16. 16.
    Sprague RS, Ramamurthy S (1990) Identification of the anterior psoas sheath as a landmark for lumbar sympathetic block. Reg Anesth 15:253–255PubMedGoogle Scholar
  17. 17.
    Sze DY, Mackey SC (2002) MR guidance of sympathetic nerve blockade: measurement of vascular response—initial experience in seven patients. Radiology 223(2):574–580PubMedCrossRefGoogle Scholar
  18. 18.
    Testut L (1897) Portion lombaire du grand sympathique ou sympathique lombaire. In Testut. Ed Octave Doin. Traité d’anatomie humaine, 3rd edn. Paris, pp 788–789Google Scholar
  19. 19.
    Thiel W (1969) Spatium retroperitoneale. In: Hafferl A (ed) Lehrbuch der topographischen Anatomie, 3rd edn. Springer Berlin, pp 554–555Google Scholar
  20. 20.
    Thiel W (2002) Ergänzung für die Konservierung ganzer Leichen nach W. Thiel. Ann Anat 184:267–269PubMedCrossRefGoogle Scholar
  21. 21.
    Umeda S, Arai T, Halano Y, Mori K, Hoshino K (1987) Cadaver anatomic analysis of the best site for chemical lumbar sympathectomy. Anesth Analg 66:643–646PubMedCrossRefGoogle Scholar
  22. 22.
    Yeager GH, Cowley RA (1948) Anatomical observations on the lumbar sympathetic with evaluation of sympathectomise in organic peripheral vascular disease. Ann Surg 127(5):953–967PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Georg C. Feigl
    • 1
    Email author
  • Manuel Kastner
    • 1
  • Heimo Ulz
    • 1
  • Christian Breschan
    • 2
  • Thomas Pixner
    • 1
  • Manuel Dreu
    • 1
  • Heinz W. Umschaden
    • 3
  • Rudolf Likar
    • 2
  1. 1.Institute of AnatomyMedical University of GrazGrazAustria
  2. 2.Department of Anaesthesiology and Pain MedicineHospital of KlagenfurtKlagenfurtAustria
  3. 3.Department of RadiologyHospital of WolfsbergWolfsbergAustria

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