The grey rami communicantes are unmyelinated postganglionic sympathetic fibres passing from the lumbar sympathetic ganglia back to the spinal nerves, carrying sympathetic innervation to the blood vessels, sweat glands, and arrector pili of the lower back and lower limbs. They connect each lumbar sympathetic ganglion to the corresponding ventral ramus.
The grey rami communicantes carry the sympathetic fibres responsible for vasomotor and sudomotor function in the lower limbs. Lumbar sympathectomy severs these rami to produce lower limb vasodilation in peripheral vascular disease and to treat hyperhidrosis. The rami are at risk during anterior lumbar spine approaches and retroperitoneal dissection. Sympathetically maintained pain in the lower limbs involves sensitisation of these rami.
Loss of lower limb sweating from grey rami communicantes division during lumbar sympathectomy, producing compensatory hyperhidrosis in other body regions and permanent lower limb anhidrosis.
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