Thoracoscopic sympathectoirty for causalgia: local experience

ABSTRACT

The purpose of this study was to assess the efficacy of thoracoscopic cervicodorsal syrnpathectomy for the reduction of pain severity and disability associated with causalgia. From 2006 - 2009, 13 patients referred to Mansoura University Hospital with causalgia. All 13 patients share the following diagnostic criteria 1] history of trauma and peripheral nerve injury, 2] burning pain, 3] sympathetic symptoms e.g. wet extremities, 4] pain aggravated by physical and/or emotional stimuli and 5] pain relieved by sympathetic block. All 13 patients underwent video-assisted thoracoscopic [lower third of stellate ganglia to T3] sympathectomy. The mechanisms of trauma include motor vehicle accidents in 3 patients, stab wound [3 patients], surgical procedure in 1 patient [carpal tunnel release], fracture [2 patients], wrong injection [1 patient], electrical injury [1 patient] and missile fragment injuries [2 patients]. The most common presenting symptoms were as follows burning pain [100%], wet extremity [100%], cold extremity in 11 cases [92%], paraesthesia 10 cases [78%], and colour changes in the extremities in 5 cases [38%]. In all patients pain was relieved by sympathetic block. All patients had complete relief of symptoms in the immediate postoperative period and for follow-up from 1-4 years. Causalgia is a syndrome associated with burning pain, hyperaesthesia and symptoms of sympathetic over-activity. Sympathectomy is effective and the treatment of choice, particularly for patients who respond temporarily to sympathetic blocks