Lumbar ganglia

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Lumbar ganglia
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Lower half of right sympathetic cord.
Details
Identifiers
Latin Ganglia lumbalia
Ganglia lumbaria
TA98 A14.3.01.033
TA2 6614
FMA 77578
Anatomical terms of neuroanatomy

The lumbar ganglia are paravertebral ganglia located in the inferior portion of the sympathetic trunk. The lumbar portion of the sympathetic trunk typically has 4 lumbar ganglia. The lumbar splanchnic nerves arise from the ganglia here, and contribute sympathetic efferent fibers to the nearby plexuses. The first two lumbar ganglia have both white and gray rami communicates.

Contents

Function

Paravertebral ganglia are divided into cervical, thoracic, lumbar, and sacral ganglia. [1] Each controls different glands and muscle groups since each muscle and gland receives input from postganglionic neurons that originated from different levels of paravertebral ganglia. [2]

The lumbar part of the sympathetic trunk contains four interconnected ganglia. Superiorly, it is continuous with thoracic sympathetic ganglion and inferiorly continuous with sacral sympathetic ganglion. Presynaptic neurons traveling from the spinal cord terminate in the paravertebral ganglia (cervical, thoracic, lumbar, sacral) or the prevertebral ganglia. They synapse with either the postsynaptic neuron of the corresponding level of the spinal cord or ascend and descend to synapse at the lower or upper paravertebral ganglia, respectively. Neurotransmitters are released in the paravertebral ganglia to activate the postganglionic neurons to send efferent sympathetic output to the lower extremities to prepare the body for the “fight or flight” responses. [1] These responses include dilating pupils, constricting blood vessels, and stimulating the secretion of acetylcholine, which causes smooth muscle contraction that leads to an increase in heart rate, blood sugar level, and blood pressure. The lumbar region L1 and L2 consist of neurons that innervate the adrenal gland, ureter, bladder, the lower extremities. The upper two lumbar ganglia (L1 and L2) of the sympathetic chain also give rise to the lumbar splanchnic nerves. Splanchnic nerves are paired visceral nerves carrying preganglionic sympathetic and general visceral afferent fibers. The lumbar splanchnic nerves travel through the lumbar sympathetic ganglion but do not synapse there. Instead, they synapse at the inferior mesenteric ganglion and innervate the smooth muscle lining the large intestines, kidney, bladder, glands of the hindgut, and pelvic viscera. [3]

Clinical Significance

Because the lumbar sympathetic nerve fibers control the muscle of the lower extremities during “fight or flight” response, treatment targeting this region can help relieve chronic leg pain. One common procedure is the lumbar sympathetic nerve block. This procedure involves an injection of an anesthetic in the sympathetic nerve tissue to block the sympathetic nerves ipsilaterally and test for any damage to the sympathetic nerve chain. By disrupting the nerve supply from the sympathetic chain to the lower extremities, monitoring the decrease of pain and swelling in these regions can help locate the origin of pain in the patient. Because the blocking procedure is safe and minimally invasive, this treatment is used for a multitude of sympathetic mediated pain disorders, including complex regional pain syndrome (CRPS) that causes dysregulation of the central and autonomic nervous system. This causes an upregulation of pain and temperature control to the extremity that is affected. However, the patient could experience an allergic reaction to the medications given during the procedure if the patient has uncontrolled diabetes, poorly controlled heart problems, or is under other medications.

Managing neuropathic pain is another use for a lumbar sympathetic block. The technique for this procedure is very specific. A fluoroscopic imaging projector is used to position the L2 and L3 to make it easily visible for the physician. The needle is aimed toward the anterior portion of the vertebral bodies of L2 and L3, and a c-arm is used to align specific views of the vertebral bodies. Since the great vessels are located ventrally to the vertebral bodies, the needle should be three to five millimeters dorsal to the most ventral portion of the vertebral body. The injection occurs once the correct position has been put in place. The physician should be able to see the coverage of the anterior portion of the vertebral body from L1 to L3. An increase by two or three degrees Celsius in the affected limb indicates a successful injection. Blood vessel dilation may also cause the affected limb to look very flushed. [4]

Related Research Articles

Autonomic nervous system Division of the peripheral nervous system supplying smooth muscle and glands

The autonomic nervous system (ANS), formerly the vegetative nervous system, is a division of the peripheral nervous system that supplies smooth muscle and glands, and thus influences the function of internal organs. The autonomic nervous system is a control system that acts largely unconsciously and regulates bodily functions, such as the heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal. This system is the primary mechanism in control of the fight-or-flight response.

Parasympathetic nervous system A division of the autonomic nervous system

The parasympathetic nervous system (PSNS) is one of the three divisions of the autonomic nervous system, the others being the sympathetic nervous system and the enteric nervous system.

Sympathetic nervous system Division of the autonomic nervous system

The sympathetic nervous system (SNS) is one of the three divisions of the autonomic nervous system, the others being the parasympathetic nervous system and the enteric nervous system.

Spinal nerve Nerve that carries signals between the spinal chord and the body

A spinal nerve is a mixed nerve, which carries motor, sensory, and autonomic signals between the spinal cord and the body. In the human body there are 31 pairs of spinal nerves, one on each side of the vertebral column. These are grouped into the corresponding cervical, thoracic, lumbar, sacral and coccygeal regions of the spine. There are eight pairs of cervical nerves, twelve pairs of thoracic nerves, five pairs of lumbar nerves, five pairs of sacral nerves, and one pair of coccygeal nerves. The spinal nerves are part of the peripheral nervous system.

Stellate ganglion

The stellate ganglion is a sympathetic ganglion formed by the fusion of the inferior cervical ganglion and the first thoracic ganglion, which exists in 80% of cases. Sometimes, the second and the third thoracic ganglia are included in this fusion. Stellate ganglion is relatively big compared to much smaller thoracic, lumbar and sacral ganglia and it is polygonal in shape. Stellate ganglion is located at the level of C7, anterior to the transverse process of C7 and the neck of the first rib, superior to the cervical pleura and just below the subclavian artery. It is superiorly covered by the prevertebral lamina of the cervical fascia and anteriorly in relation with common carotid artery, subclavian artery and the beginning of vertebral artery which sometimes leaves a groove at the apex of this ganglion.

Pterygopalatine ganglion

The pterygopalatine ganglion is a parasympathetic ganglion found in the pterygopalatine fossa. It is largely innervated by the greater petrosal nerve ; and its axons project to the lacrimal glands and nasal mucosa. The flow of blood to the nasal mucosa, in particular the venous plexus of the conchae, is regulated by the pterygopalatine ganglion and heats or cools the air in the nose. It is one of four parasympathetic ganglia of the head and neck, the others being the submandibular ganglion, otic ganglion, and ciliary ganglion.

Prevertebral ganglia

Prevertebral ganglia are sympathetic ganglia which lie between the paravertebral ganglia and the target organ.

Superior cervical ganglion

The superior cervical ganglion (SCG) is part of the autonomic nervous system (ANS), more specifically it is part of the sympathetic nervous system, a division of the ANS most commonly associated with the fight or flight response. The ANS is composed of pathways that lead to and from ganglia, groups of nerve cells. A ganglion allows a large amount of divergence in a neuronal pathway and also enables a more localized circuitry for control of the innervated targets. The SCG is the only ganglion in the sympathetic nervous system that innervates the head and neck. It is the largest and most rostral (superior) of the three cervical ganglia. The SCG innervates many organs, glands and parts of the carotid system in the head.

Each spinal nerve receives a branch called a gray ramus communicans from the adjacent paravertebral ganglion of the sympathetic trunk. The gray rami communicantes contain postganglionic nerve fibers of the sympathetic nervous system and are composed of largely unmyelinated neurons. This is in contrast to the white rami communicantes, in which heavily myelinated neurons give the rami their white appearance.

Sympathetic ganglion Ganglia of the sympathetic nervous system

The sympathetic ganglia, or autonomic ganglia, are the ganglia of the sympathetic nervous system. Ganglia are 20,000 to 30,000 afferent and efferent nerve cell bodies that run along on either side of the spinal cord. Afferent nerve cell bodies bring information from the body to the brain and spinal cord, while efferent nerve cell bodies bring information from the brain and spinal cord to the rest of the body. The cell bodies create long sympathetic chains that are on either side of the spinal cord. They also form para- or pre-vertebral gangalia of gross anatomy.

Lateral grey column

The lateral grey column is one of the three grey columns of the spinal cord ; the others being the anterior and posterior grey columns. The lateral grey column is primarily involved with activity in the sympathetic division of the autonomic motor system. It projects to the side as a triangular field in the thoracic and upper lumbar regions of the postero-lateral part of the anterior grey column.

Sacral splanchnic nerves

Sacral splanchnic nerves are splanchnic nerves that connect the inferior hypogastric plexus to the sympathetic trunk in the pelvis.

Cervical ganglia

The cervical ganglia are paravertebral ganglia of the sympathetic nervous system. Preganglionic nerves from the thoracic spinal cord enter into the cervical ganglions and synapse with its postganglionic fibers or nerves. The cervical ganglion has three paravertebral ganglia:

General visceral afferent fiber

The general visceral afferent (GVA) fibers conduct sensory impulses from the internal organs, glands, and blood vessels to the central nervous system. They are considered to be part of the visceral nervous system, which is closely related to the autonomic nervous system, but 'visceral nervous system' and 'autonomic nervous system' are not direct synonyms and care should be taken when using these terms. Unlike the efferent fibers of the autonomic nervous system, the afferent fibers are not classified as either sympathetic or parasympathetic.

Thoracic ganglia

The thoracic ganglia are paravertebral ganglia. The thoracic portion of the sympathetic trunk typically has 12 thoracic ganglia. Emerging from the ganglia are thoracic splanchnic nerves that help provide sympathetic innervation to abdominal structures. The thoracic part of sympathetic trunk lies posterior to the costovertebral pleura and is hence not a content of the posterior mediastinum

Outline of human anatomy Overview of and topical guide to human anatomy

The following outline is provided as an overview of and topical guide to human anatomy:

Spinal cord Long, tubular central nervous system structure in the vertebral column

The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column. It encloses the central canal of the spinal cord, which contains cerebrospinal fluid. The brain and spinal cord together make up the central nervous system (CNS). In humans, the spinal cord begins at the occipital bone, passing through the foramen magnum and entering the spinal canal at the beginning of the cervical vertebrae. The spinal cord extends down to between the first and second lumbar vertebrae, where it ends. The enclosing bony vertebral column protects the relatively shorter spinal cord. It is around 45 cm (18 in) in men and around 43 cm (17 in) long in women. The diameter of the spinal cord ranges from 13 mm in the cervical and lumbar regions to 6.4 mm in the thoracic area.

Outline of the human nervous system Overview of and topical guide to the human nervous system

The following Diagram is provided as an overview of and topical guide to the human nervous system:

Roots of the ciliary ganglion

The ciliary ganglion is a parasympathetic ganglion located just behind the eye in the posterior orbit. Three types of axons enter the ciliary ganglion but only the preganglionic parasympathetic axons synapse there. The entering axons are arranged into three roots of the ciliary ganglion, which join enter the posterior surface of the ganglion.

References

  1. 1 2 Purves, Dale; Augustine, George J.; Fitzpatrick, David; Katz, Lawrence C.; LaMantia, Anthony-Samuel; McNamara, James O.; Williams, S. Mark (2001). "The Sympathetic Division of the Visceral Motor System". Neuroscience. 2nd Edition.
  2. ↑ Purves, Dale; Augustine, George J.; Fitzpatrick, David; Katz, Lawrence C.; LaMantia, Anthony-Samuel; McNamara, James O.; Williams, S. Mark (2001). "Motor Neuron-Muscle Relationships". Neuroscience. 2nd Edition.
  3. ↑ McCausland, Cassidy; Sajjad, Hussain (2020), "Anatomy, Back, Splanchnic Nerve", StatPearls, StatPearls Publishing, PMID   31751046 , retrieved 2020-05-11
  4. ↑ Alexander, Christopher E.; Varacallo, Matthew (2020), "Lumbar Sympathetic Block", StatPearls, StatPearls Publishing, PMID   28613759 , retrieved 2020-05-11


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