Residual Sympathetic Pathways after Paravertebral Sympathectomy

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Abstract
291 sympathectomies were done in 151 patients, removing various portions of the ganglionated cord up to and including "total" ablation (stellate ganglion through L5). Persistence of sympathetic function, and paradoxically early return of sympathetic activity, were observed in the "denervated" dermatomes, as detd. by measurements of electrical skin resistance in all patients, plus a few simultaneous observations on surface temperature and color, gross sweating response, and blood pressure changes. Such residual activity is sometimes interrupted by ant. rhizotomy, spinal anesthesia, tetraethylammonium, and procaine block or surgical division of the lumbar nerves. Central "readjustment", invasion by adjacent (intact) sensory nerves, and regeneration may explain some survival or early return; no explanation is offered, however, for persistent function after complete removal of the paravertebral system. There are evidently sympathetic pathways to the lower limbs which do not pass through any part of the paravertebral chain.