Lumbar sympathectomy

 The procedure aims to increase blood supply to your legs by cutting the nerves responsible for constricting (narrowing) your arteries. It may be used to treat:

• Leg or foot ulcers that will not heal
• Chronic leg and foot pain due to poor blood supply
• Leg and back pain due to spinal stenosis (narrowing of the spinal canal)
• Excessive sweating (hyperhidrosis) of the feet

A lumbar sympathectomy is normally performed when other treatments such as medication and physiotherapy haven’t worked. It won’t typically be the first treatment tried.

At your first consultation, you will be seen by a consultant in pain management, a doctor specialising in the treatment of pain.

Your consultant will ask you about your symptoms and perform a physical examination. They will ask you about your medical history and any previous treatments or surgeries you have had.

To determine whether lumbar sympathectomy is the right treatment for you, your consultant may order tests and scans including:

• Blood tests
• Computerised tomography (CT) scan
• Magnetic resonance imaging (MRI)
• X rays

How is a diagnosis made?

A diagnosis is made from a combination of your symptoms, physical examination, and the results of your tests and scans.

Why is this first consultation so important?

At Circle Health Group, your first appointment is very important as it's where your consultant will ask you about your symptoms, perform a physical examination, order any necessary tests, provide a diagnosis, and discuss possible treatments.

Your first consultation is also where we get to know you, discuss your expectations for treatment, and encourage you to ask any questions you may have.

It is important to us that you are as well-informed and comfortable as possible before, during, and after your procedure, so please ask your consultant any questions you may have.

Your consultant will give you instructions on how to prepare for your lumbar sympathectomy before your procedure. Make sure you understand what you need to do and ask any questions you may have.

To prepare for your lumbar sympathectomy:

• Tell your consultant about any medical conditions or allergies you have
• Tell your consultant about any medications you are taking including over-the-counter medications, vitamins, and supplements
• If you are taking blood thinners such as aspirin or warfarin, your consultant may tell you to stop taking them for a few days before the procedure. This is to reduce the risk of bleeding during and after the surgery.
• You will not be able to eat or drink anything from midnight on the day of your procedure. You can take your regular medications with a small amount of water 
• Wear comfortable clothes to the hospital and remove all jewellery, makeup, and nail varnish

Lumbar sympathectomy surgery may be different for everyone and what will happen during your operation depends on your individual circumstances. Your consultant will explain what will happen during your procedure.

Knowing what to expect and being well-prepared for your surgery can help put your mind at rest and reduce any anxiety you may have. Please feel free to ask your consultant any questions and discuss any concerns you may have at any time.

Lumbar sympathectomy is performed under a general anaesthetic meaning you'll be asleep for the procedure.

The procedure is carried out using laparoscopic (keyhole) surgery. This is where a flexible camera and instruments are inserted through small incisions (cuts) in your abdomen. Once located, the nerves are cut or cauterised (burnt using heat or chemicals) to permanently block them.

Lumbar sympathectomy normally takes around one to two hours.

After your procedure, you will be taken to the recovery room where you will be monitored until you are ready to return to your room.

You will need to spend one night in hospital and will be able to go home the next day. It is advisable to have someone with you for twenty-four hours after your surgery.

You may have mild pain from your incisions for a few days after your surgery, but your consultant will prescribe pain medications to help with this. Your consultant will advise you on how to keep your incision sites clean. Avoid swimming or taking baths until your consultant tells you it is safe to do so.

Can I drive home from the hospital?

You will not be able to drive yourself home from the hospital, or for twenty-four hours after your surgery. You can arrange for someone to come and collect you, or we can order a taxi if you prefer.

How soon can I go back to work?

How soon you can return to work depends on your recovery and the type of job you do. Your incisions will take about a week to heal after the procedure, and you can expect to be off work for about this time.

After your surgery, you can walk around and carry out light tasks, but avoid strenuous activity or heavy lifting for about a week after your procedure. Talk to your consultant about when you can expect to return to work after your surgery.

When will I be back to normal after lumbar sympathectomy?

Recovery after lumbar sympathectomy is different for everyone and depends on many factors such as your age, general health, and whether there were any complications during your surgery.

To give yourself the best chance of recovery:

• Be as well-informed and prepared as possible before your surgery
• Follow your consultant's instructions before and after your surgery and ask any questions you may have
• Take any medications your consultant has prescribed as directed
• Gradually build up your activity level over a few days
• Recover at your own pace and don't try to do too much too quickly after your surgery

Lumbar sympathectomy is a minimally invasive surgery as it is carried out laparoscopically and no large incisions are made. Recovery is normally much faster than with open surgery and you can expect to be back to normal within one to two weeks. Talk to your consultant about when you can expect to be back to normal after your surgery.

Like all surgery, lumbar sympathectomy carries a small risk of complications. Your consultant will explain these to you before your operation and answer any questions you have to allow you to make an informed decision.

General risks of surgery include:

• Bleeding
• Infection
• Blood clots
• Adverse reaction to the anaesthetic

Risks specific to lumbar sympathectomy include:

• Damage to surrounding nerves

We answer some of your most commonly asked questions about lumbar sympathectomy

What's the difference between a lumbar sympathectomy and a lumbar nerve block?

A lumbar sympathectomy is a surgical procedure where the sympathetic nerves in the lumbar region of the spine are cut or cauterised to permanently disable them. A nerve block is when the nerves are injected with phenol, a hardening agent that reduces pain. A lumbar nerve block typically lasts around nine months.

How successful is lumbar sympathectomy treatment?

Lumbar sympathectomy is an effective procedure and studies¹ have shown it can improve symptoms of reduced blood supply (ischaemia), inflammation of the blood vessels (vasculitis), nerve damage caused by diabetes (diabetic neuropathy) and excessive sweating of the legs and feet (hyperhidrosis).

At Circle Health Group we have the experience and expertise to ensure the best possible care and outcome for our patients. As a patient with Circle Health Group you can expect the highest standards of care including:

• Flexible appointment times and locations that are convenient for you
• The freedom to choose which hospital and consultant best suit your needs
• Personalised, consultant-led treatment plans tailored to your individual needs
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standard
• A range of delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to see a consultant or learn more about lumbar sympathectomy, book your appointment online today or call a member of our team directly on 0141 300 5009.

Content reviewed by Circle in-house team in December 2022. Next review due December 2025.

1. Lumbar sympathectomy, NHS Hull University Teaching Hospitals
2. Lumbar Sympathectomy, Science Direct
3. Lumbar sympathectomy techniques for critical lower limb ischaemia due to non‐reconstructable peripheral arterial disease, PubMed
4. Lumbar Sympatholysis, PubMed
5. Lumbar sympathectomy can improve symptoms associated with ischaemia, vasculitis, diabetic neuropathy, and hyperhidrosis affecting the lower extremities-a single-centre experience, PubMed