Prevalence and Clinical Outcome of Sympathetic Chain Injury after Anterior Approach to Upper Lumbar Fractures

Background data: The sympathetic chain is a vulnerable structure in anterior reconstructive surgeries to upper lumbar fractures. Purpose: To explore the prevalence of sympathetic chain injuries following the anterior surgical approach to treat upper lumbar fractures and their impact on clinical outcomes. Study design: A nonrandomized prospective cohort study. Patients and Methods: Consecutive cases with upper lumbar fractures that undergone surgery by either anterior or posterior approaches were preoperatively and postoperatively evaluated for sympathetic chain injury and followed up six months after surgery to explore outcomes. Two simple, valid, and reliable bedside tests were used to assess sympathetic functions: the skin wrinkling test (SWT) and the skin temperature difference (STD). Outcomes were assessed using the Oswestry Disability Index (ODI) and the 12-Item Short Form Survey (SF-12) at six months in both positive and negative groups with sympathetic injury. Results: The 2 approach groups (32 cases each) showed comparable demographic and clinical criteria. The SWT showed high interrater reliability with agreement in 92% of cases. The positive group with confirmed sympathetic injury included 29 cases, all of which belonged to the anterior approach group. The negative group with equivocal or confirmed intact sympathetic function included 35 cases; 3 of them belonged to the anterior group. The ODI and SF-12 scores were found to be comparable between positive and negative groups 6 months after surgery. Conclusion: Sympathetic chain injury is a frequent complication (90.6% of cases) following the anterior approach to upper lumbar fractures. The cases are unilateral, relatively silent, and related to the side of approach with no clinical impact on quality of life on 6-month outcome assessment. (2020ESJ201)