In lumbar sympathectomy, which root value is spared?
Buerger's disease: Characterized by - Reynaud's phenomena + intermittent claudication +migratory superficial thrombophlebitis Also called thromboangiitis obliterans Over a time, patient can present with cutaneous ischemia causing wrist pain -for which sympathectomy is done LUMBAR SYMPATHECTOMY Open sympathectomy is done preferably through extra peritoneal approach Sympathetic chain lies on the sides of body of veebra, sometimes inside psoas muscle sheath In unilateral surgeries, sympathetic gangliaL1,L2,L3 and sometimes L4 are removed In bilateral surgeries, L1 of one side is preferred to avoid retrograde ejaculation Lumbar chain can be mistaken with lymphatic chain, genitofemoral nerve psoas sheath, psoas minor leading to technical
L1
L2
L3
L4
JIPMER 2017