Is section of the sympathetic rami communicantes by laparoscopy in patients with refractory low back pain efficient?

Objective: The objective of this prospective innovative treatment is to section the pain pathways carried by sympathetic lumbar rami communicantes to achieve lasting pain relief of refractory low back pain.

Methods: From December 2005 to September 2008, nine patients were operated by bilateral section of rami communicantes for a refractory low back pain. As a diagnostic and predictive test, all patients had, before surgery, a local anaesthetic infiltration of the sympathetic trunk at L2 performed with computed tomography guidance. Surgery is indicated if the tests lead to a reduction in pain of at least 50 %. The procedure, using a retroperitoneal laparoscopic approach, consisted to identify the sympathetic trunk and to section all lumbar rami communicantes from L1 to L2.

Results: No intraoperative complications were observed. The mean postoperative follow-up was 29 ± 15 months. At the last follow-up, only 22 % (2/9) patients had an improvement of their low back pain with this surgery but with a minimal effect (30 and 50 % reduction of pain). An improvement of quality of life was observed in 33 % (3/9) of cases. Due to persistent pain, four patients had a spinal cord stimulation after this surgery.

Conclusions: Section the pain pathways carried by sympathetic lumbar rami communicantes for refractory low back pain improved 22 % of patients at the last follow-up of 29 months.