Clinical characteristics of sympathetic chain injury after oblique lateral interbody fusion: underestimated incidence

English Keywords:Lumbar degenerative diseases  Lumbar sympathetic chain injury  Oblique lateral interbody fusion

English Abstract:

  【Abstract】 Objectives： To investigate the incidence and clinical characteristics of sympathetic chain injury after oblique lateral lumbar interbody fusion(OLIF). Methods： The data of 54 patients with lumbar degenerative diseases who underwent OLIF in the Department of Orthopedics of our hospital from April 2016 to December 2017 were retrospectively analyzed, which included 10 males and 44 females, aged 37-80 years (58.4±10.9 years). There were 18 cases of lumbar spondylolisthesis, 12 cases of lumbar instability, 8 cases of lumbar disc herniation, 14 cases of lumbar degenerative scoliosis, and 2 cases of postoperative recurrence of lumbar disc herniation. Of all patients, single segment OLIF was performed in 39 cases and multi-segment OLIF was performed in 15 cases, and left approaches were adopted in 52 cases, while right approaches were adopted in 2 cases. The body surface temperature of both legs and dorsum of both feet was measured by electronic induction thermometer before operation and on the next day after operation, and the temperature difference of both legs or dorsum of feet ≥0.5℃ was defined as the temperature difference of lower limbs, and lumbar sympathetic chain injury was diagnosed. The symptoms of lower limbs after operation were recorded. The patients were followed up at 1 week, 6 weeks, 6 months and 2 years after operation, using Likert five-scale to evaluate the discomfort experience caused by sympathetic chain injury. Results： There was no statistically significant difference in the surface temperature of both lower limbs before operation in 54 patients(P>0.05), and there was unequal surface temperature of both lower limbs in 16 patients(29.6%) after operation, including 15 women(34.1%) and 1 man(10%). The incidence of female patients was higher than that of male patients, but the difference was not statistically significant(P>0.05), including 4 cases of lumbar spondylolisthesis (4/18, 22.2%) and 4 cases of lumbar instability(4/12, 33.3%), Lumbar disc herniation(3/8,37.5%) and lumbar degenerative scoliosis(6/14, 35.7%), the difference was not statistically significant(P>0.05); There were 10 patients with single segment(24%) and 6 patients with multi segment(46%). The incidence of multi segment OLIF was significantly higher than that of single segment OLIF(P<0.05). After operation, 8 patients(14.8%) felt that the skin temperature of both lower limbs was unequal, and 12 patients(22.2%) had pain, numbness and quadriceps femoris weakness in front of thigh. There was no significant difference between patients with sympathetic chain injury and patients without sympathetic chain injury(P>0.05). The temperature of left leg was 36.1±0.2℃, that of right leg was 36.1±0.3℃ and that of left foot was 36.0±0.2℃, The temperature of the right foot was 35.9±0.3℃, the temperature of the left leg was 36.7±0.3℃, the temperature of the right leg was 36.1±0.3℃, the temperature of the left foot was 36.7±0.3℃, the temperature of the right foot was 35.8±0.4℃, the temperature difference between the two legs was 0.6±0.1℃ and the temperature difference between the feet was 0.9±0.3℃ on the first day after operation; The temperature difference varies for 1.5-12 months. One week after operation, the subjective experience was evaluated by Likert five subscale method: poor in 2 cases(12.5%), medium in 14 cases(87.5%); 2 cases improved at 6 weeks and 6 cases improved at 6 months, of which 1 case improved from poor to medium. After 2 years of follow-up, 2 cases improved from poor to medium, and 7 cases improved from medium to good. Conclusions： The measurement of the surface temperature of both lower limbs by electronic induction thermometer can assist the diagnosis. The incidence of sympathetic chain injury in patients with multi-level OLIF is higher than that in patients with single-level OLIF. The subjective experience of sympathetic nerve chain injury in most patients was moderate discomfort.