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

 Ji Won An  ;  Jae Chul Koh  ;  Jong Min Sun  ;  Ju Yeon Park  ;  Jong Bum Choi  ;  Myung Ju Shin  ;  Youn Woo Lee 
 KOREAN JOURNAL OF PAIN, Vol.29(2) : 103-109, 2016 
Journal Title
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Clinical identification ; Lumbar ; Neurolytic ; Radiofrequency ; Sympathetic ganglia ; Vertebral level
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.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Koh, Jae Chul(고재철)
Shin, Myung Ju(신명주)
An, Ji Won(안지원)
Lee, Youn Woo(이윤우)
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