Dysautonomia as a Surgical Complication of Transdiaphragmatic Approach to Thoracolumbar Fractures

Abstract

Objective: A Quasi-experimental study was conducted to observe the effects of sympathetic chain resection or mobilization in patients with dorsolumbar fractures undergoing anterior decompression and stabilization.

Materials and Methods: Patients with thoracolumbar traumatic fractures who underwent anterior decompression and fixation were included. Autonomic sympathetic effects were studied by checking cutaneous temperature at the dorsum of the feet, plantar ninhydrin sweat test, and sympathetic skin response on the dorsum of the foot by electrical stimulation.

Results: 33 patients were operated on for thoracolumbar fractures. Sympathetic changes were more prominent at combined L1 and L2 fractures (18%) as compared to D11, D12 (90%) in the early postoperative period. Affected limb temperature increased in (57.5%), with positive ninhydrin test in 54.5% and Negative in 57.5%. Average difference in cutaneous temperature on the right side = 96.01°F and on the left side = 96.7°F. The average mean difference on both sides was 1.66°F. Sympathetic skin response was positive in 57.5% and Negative in 54.5% of cases. Nerve conduction studies revealed reduced amplitude and prolonged latencies, asymmetrical, L>R, of bilateral. Permanent sympathetic damage was observed in 9% and, temporary damage in 72%, and 18% were fail to follow up after six months.

Conclusion: Unilateral thoracolumbar sympathetic chain mobilization or resection (ramisectomy or ganglionectomy) leads to cutaneous temperature elevation, decreased sweating, decreased SPO2, and trophic changes on the operative side. Thus, the sympathetic chain should be handled with care to avoid sympathetic dysautonomia in the lower limbs.