The sympathetic nervous system is responsible for controlling many of the processes in the body that we do not consciously or routinely think about. If you have ever heard of the “fight or flight” response in which the body prepares either to defend itself or run away, then you already know something about the sympathetic nervous system. This nervous system oversees many of the things that we cannot directly or easily control with our minds.
One of the bodily processes controlled by the sympathetic nervous system is the process of sweating. When the body temperature rises, the sympathetic nervous system reacts by causing us to perspire or sweat in order to cool down our skin. Unfortunately, this process does not always occur normally. In some people, sweating occurs regardless of body temperature and to excessive amounts.
Hyperhidrosis is a condition in which the body produces excessive amounts of sweat, regardless of body temperature. It can occur all over the body, but often afflicts the hands and feet predominately. Patients with severe hyperhidrosis can lose significant amounts of water from the body in the form of sweat, so much so that they risk dehydration.
There are various medical treatments for hyperhidrosis but, if they fail, surgical treatment is necessary. Lumbar sympathectomy is a relatively new surgical treatment for hyperhidrosis of the feet.
The main part of the sympathetic nervous, the sympathetic chain, runs right along the spine, but outside of the spinal cord itself. The sympathetic chain sends off nerve fibers to control various organs and body processes. In a lumbar sympathectomy, the bottom part of the sympathetic chain is surgically disrupted. It is this bottom part of the sympathetic chain, the lumbar region, that controls sympathetic nervous system functions of the lower extremities (legs).
The major advantage of a lumbar sympathectomy over a thoracic sympathectomy or other surgical approach is that a lumbar sympathectomy can correct excessive sweating in the feet without affecting other important sympathetic nervous system processes, like heart rate regulation.
Since lumbar sympathectomy only cuts a small area, most procedures are done endoscopically or laparoscopically. This means that a lumbar sympathectomy can be an outpatient or “same day” procedure. A few small incisions are made in the back, near the waist, through which a tiny camera and instruments can be passed into the body. Once the proper region is identified, it is simply cut away from the rest of the sympathetic chain. The patient is under general anesthesia for the procedure and the recovery period is usually quite short.
Since both feet are usually affected by severe hyperhidrosis, a bilateral lumbar sympathectomy is usually performed. A bilateral lumbar sympathectomy is one in with the sympathetic chain is cut on both sides of the body.
The success rate for lumbar sympathectomy is greater than 95%, even in patients that have failed to find relief from medical treatments. Lumbar sympathectomy, though, is considered a last resort in hyperhidrosis treatment. Lumbar sympathectomy side effects include problems with low blood pressure and impotency in men. Recent advances in the lumbar sympathectomy technique have greatly reduced the frequency of these complications such that the procedure is now quite safe and effective in skilled hands.