The amount of compensatory sweating depends on the patient, the damage that the white rami communicans incurs, and the amount of cell body reorganization in the spinal cord after surgery.
Other potential complications include inadequate resection of the ganglia, gustatory sweating, pneumothorax, cardiac dysfunction, post-operative pain, and finally Horner’s syndrome secondary to resection of the stellate ganglion.
www.ubcmj.com/pdf/ubcmj_2_1_2010_24-29.pdf

After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration
After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within a year.
http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract

Wednesday, January 16, 2008

MSAC ON SYMPATHECTOMY

The Medicare Benefits Schedule (MBS) has evolved over time in response to changes in medical practice. Medicare benefits are payable in respect of a medical service listed in the MBS where that service is:
  • provided by a medical practitioner, and
  • a clinically relevant service (generally accepted in the medical profession as being necessary for the appropriate treatment of the patient).

Medicare item 35003 relates to the performance of cervical or upper thoracic sympathectomy by any surgical approach (irrespective of whether it is conducted by open exposure or endoscopically). Sympathectomy has been listed on the MBS for over three decades, and permitted by any surgical approach since 1991.

The Medical Services Advisory Committee (MSAC) was established in 1998 to advise the Minister for Health and Ageing on the strength of evidence pertaining to new and emerging medical technologies and procedures in relation to their safety, effectiveness and cost-effectiveness and under what circumstances public funding should be supported. MSAC has never considered this procedure, as it was listed on the MBS prior to MSAC's formation, and is therefore not a 'new and emerging medical technology'.

The Government relies on the advice of the medical profession in relation to the clinical relevance of procedures already listed on the MBS. If the Royal Australasian College of Surgeons were to formally advise the Government that it no longer regards this procedure as being clinically relevant, the Government would take appropriate action in relation to the MBS.