The lumbar sympathetic trunk is the continuation of the thoracic sympathetic chain as it passes posterior to the medial arcuate ligament into the retroperitoneum. It descends along the anterolateral surface of the lumbar vertebral bodies medial to the psoas major, typically bearing four ganglia at each lumbar level. It gives grey rami communicantes to each lumbar spinal nerve and lumbar splanchnic nerves to the abdominal and pelvic autonomic plexuses.
| Origin | Continuation of the thoracic sympathetic trunk |
|---|---|
| Course | Enters the abdomen behind the medial arcuate ligament and descends on the anterolateral lumbar vertebral bodies along the medial border of psoas, behind the inferior vena cava on the right and lateral to the aorta on the left, continuing behind the common iliac vessels into the pelvis |
| Sensory |
|
Lumbar sympathectomy, done chemically by phenol or alcohol injection or surgically by removing ganglia, is used for chronic lower limb ischaemia when revascularisation is not possible, complex regional pain syndrome of the lower limb, plantar hyperhidrosis and Raynaud phenomenon. Percutaneous block or neurolysis is performed under CT or fluoroscopic guidance at about L2-L3, just in front of the anterolateral margin of the vertebral body. The right trunk lies behind the inferior vena cava and the left beside the aorta, so both are exposed in retroperitoneal and anterior lumbar spine approaches. Genitofemoral neuralgia, from injury to the genitofemoral nerve on psoas, is a recognised complication of sympathectomy.
Chemical or surgical sympathectomy blocks sympathetic vasoconstriction and can relieve sympathetically maintained pain in lower limb complex regional pain syndrome, usually after a positive diagnostic block.
The genitofemoral nerve on psoas can be injured during lumbar sympathectomy, causing groin, genital and upper medial thigh pain.
Retraction of psoas and the great vessels during anterior or lateral lumbar interbody fusion can injure the trunk, producing a warm, dry ipsilateral leg and foot from loss of sympathetic tone; it is usually harmless but can alarm patients.
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