1. 2022;25;E357-E364Comparison of Efficacy and Safety of Lumbar Sympathetic Radiofrequency Thermocoagulation Versus Chemical Lumbar Sympathectomy in the Treatment of Cold Hypersensitivity in the Hands and Feet: A Retrospective Study
   Retrospective Study
   Keyue Xie, MD, Huadong Ni, PhD, Qiuli He, MD, Jianjun Zhu, MD, Ge Luo, MD, Jiayi Tang, MD, Bing Huang, MD, Jiachun Tao, MD, and Ming Yao, PhD.

BACKGROUND: Cold hypersensitivity in the hands and feet (CHHF) is a disease characterized by abnormal cold in the limbs with limited treatment options. Compared to traditional drug therapy, lumbar sympathectomy is a new minimally invasive surgical method for treating CHHF.

OBJECTIVES: The present study aimed to compare the efficacy and safety of lumbar sympathetic radiofrequency thermocoagulation (RFT) and chemical lumbar sympathectomy (CLS) in treating CHHF.

STUDY DESIGN: A single-center, retrospective, observational study.

SETTING: Department of Anesthesiology and Pain Medicine, Jiaxing, China.

METHODS: A total of 102 patients with CHHF who underwent lumbar sympathectomy from January 2016 to April 2020 were included in this study. According to the mode of operation, the patients were divided into 2 groups: CLS (n = 56) and RFT (n = 46). All patients were treated under the guidance of computed tomography (CT). The foot temperature (T) and peripheral perfusion index (PI) were compared between the 2 groups before and after treatment. The 2 groups’ visual analog scale (VAS) scores were evaluated before the operation and 1 day, 1 month, 3 months, 6 months, and 1 year after the treatment. The postoperative recurrence rate of the 2 groups was observed 1 year after treatment. The short and long-term complications during the postoperative follow-up were recorded.

RESULTS: All patients completed the operation successfully. No significant difference was noted in the gender, age, course of the disease, preoperative T and PI, and postoperative T and PI between the 2 groups (P > 0.05). The postoperative T and PI were significantly increased compared to preoperative in both groups (P < 0.05). No significant difference was observed in T and PI between the 2 groups (P > 0.05), and no significant difference was recorded in VAS scores between the 2 groups 1 day and 1 month after the treatment (P > 0.05). The VAS scores at 3 months, 6 months, and 1 year after the treatment were significantly lower in the RFT group compared to the CLS group (P < 0.05). During the 1-year follow-up, patients who received CLS had a higher risk of recurrence than RFT treatment (P < 0.05). The RFT group treatment of CHHF showed better long-term outcomes than the CLS group. About 12.5% of patients in the CLS group and 6.5% in the RFT group had postoperative complications, including pain at the puncture site and genitofemoral neuralgia. However, no severe complications or deaths were observed in either of the 2 groups.

LIMITATIONS: The was a single-center, retrospective, non-randomized study, which is a major limitation of this study.

CONCLUSIONS: Lumbar sympathetic RFT had better long-term efficacy, lower recurrence, and fewer complications than the chemical lumbar sympathectomy when treating CHHF.

KEY WORDS: Cold hypersensitivity, sympathetic, radiofrequency thermocoagulation, chemical lumbar sympathectomy