The morphology of lumbar sympathetic trunk in humans: a cadaveric study

Abstract

The vasospastic diseases and chronic pain related to lower limb have been successfullytreated by surgical ablation of lumbar sympathetic trunk for last 80 years.Precise knowledge of anatomy of lumbar sympathetic trunk and its adjoiningstructures is mandatory for safe and uncomplicated lumbar and spinal surgeries.We aim to study the detailed anatomy of entry and exit of lumbar sympathetictrunk, the number, dimensions and location of lumbar ganglia in relation tolumbar vertebra. Thorough dissection was carried out in 30 formalin embalmedcadavers available in the Department of Anatomy, Pravara Institute of MedicalSciences (PIMS), Rural Medical College (RMC), Loni, Maharashtra. A total of238 ganglia were observed in 60 lumbar sympathetic trunks. The sympathetictrunk traversed dorsal to the crus of diaphragm in 72.6% and in 13.3% it entereddorsal to the medial arcuate ligament. The most common site of the location oflumbar ganglia was in relation to the second lumbar vertebra, sometimes extendingup to the L2–L3 vertebral disc. There was a medial shift of sympathetictrunk in lumbar region and it coursed over sacral promontory to reach the pelvicregion in 96% of specimens. These variations should be kept in mind in order toprevent hazardous complications like accidental avulsion of first lumbar gangliaand genitofemoral neuritis.