Clinical Identification of the Vertebral Level at Which the Lumbar Sympathetic Ganglia Aggregate

BACKGROUND: The location and the number of lumbar sympathetic ganglia (LSG) vary between individuals. The aim of this study was to determine the appropriate level for a lumbar sympathetic ganglion block (LSGB), corresponding to the level at which the LSG principally aggregate. METHODS: Seventy-four consecutive subjects, including 31 women and 31 men, underwent LSGB either on the left (n = 31) or the right side (n = 43). The primary site of needle entry was randomly selected at the L3 or L4 vertebra. A total of less than 1 ml of radio opaque dye with 4% lidocaine was injected, taking caution not to traverse beyond the level of one vertebral body. The procedure was considered responsive when the skin temperature increased by more than 1℃ within 5 minutes. RESULTS: The median responsive level was significantly different between the left (lower third of the L4 body) and right (lower margin of the L3 body) sides (P = 0.021). However, there was no significant difference in the values between men and women. The overall median responsive level was the upper third of the L4 body. The mean responsive level did not correlate with height or BMI. There were no complications on short-term follow-up. CONCLUSIONS: Selection of the primary target in the left lower third of the L4 vertebral body and the right lower margin of the L3 vertebral body may reduce the number of needle insertions and the volume of agents used in conventional or neurolytic LSGB and radiofrequency thermocoagulation.

Changes in Length of the Spinal Cord and Vertebral Level of the Termination of the Spinal Cord in Korean Fetuses / 체질인류학회지

It has been reported that there are racial differences in the vertebral level of termination of the spinal cord (VLTS) in fetuses. However, the precise analysis about the differences has not been established because the definition of the termination of the spinal cord used in comparing the VLTS was different from one another. The purpose of this study is to measure the VLTS, the length of the spinal cord and vertebral column in Korean fetuses, and to compare the VLTS with that of other nations or races according to the different definitions of the termination of the spinal cord. Two points were considered to measure the length and vertebral level of the spinal cord: One point was where the lowest spinal nerve root emerges (termination of the spinal cord I, SCT I), and the other was the point at which the tapering of the conus medullaris suddenly stops, and after which the diameter remains about the same (termination of the spinal cord II, SCT II). Materials used for this study were 115 normal Korean fetuses ranging from 13th to 37th weeks after the onset of the last normal menstrual period (LNMP). The fetuses were subdivided into 7 groups by gestational age and crownrump length (CRL), respectively. The results were obtained as follows. 1. All lengths of the vertebral column (VCL), spinal cord (SCL) and dura mater (DML) increased with the increase in fetal age, but the rate was somewhat different from one another. Especially, the increase rate of SCL was lowered at 6th month of gestation (Group III). Recession lengths of the two terminations of the spinal cord were also greatest in Group III and the ratio of SCL to VCL was also decreased greatly in Group III. These findings indicate that the relative growth rate of the spinal cord to the vertebral column is lowest during the 6th month, and as a result, the spinal cord ascends most rapidly during this stage of development. The number of cases after 8th month was so few that we could not make any conclusion. 2. With the increase in fetal age, vertebral level and range of the termination of the spinal cord and the dura mater increased gradually. In comparison of our results with others, we confirmed that the vertebral level of the termination of the spinal cord in Korean fetus is similar to that of Saudi Arabian, but is somewhat higher than that of the English, North Indian and South Indian. 3. There was no statistically significant difference between male and female in all measurements except for a very few ones.