PHYSIOLOGICAL-CHANGES OF NERVE ROOT DURING POSTERIOR LUMBAR DISKECTOMY

被引：44

作者：

MATSUI, H

KITAGAWA, H

KAWAGUCHI, Y

TSUJI, H

机构：

[1] Department of Orthopaedic Surgery, Toyama Medical and Pharmaceutical University, Toyama

来源：

SPINE | 1995年 / 20卷 / 06期

关键词：

Blood flow; Electrophysiology; Lumbar spine; Nerve root; Posterior discectomy;

D O I：

10.1097/00007632-199503150-00004

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Study Design and Objectives. The effects of nerve root retraction in posterior discectomy on pressure, blood flow, and electrophysiologic changes of the nerve root were investigated. Objectives. This study was performed to assess the effects of nerve rot retraction in posterior discectomy on pressure, blood flow, and electrophysiologic changes of the nerve root. Summary of Background Data. The effects of compression on nerve tissue have been clinically studied mainly in peripheral nerves. The potential risk for lumbar nerve root injury has not been evaluated precisely in humans. Methods. Among 31 patients with lumbar intervertebral disc herniation, the correlation between retraction pressure and changes in blood flow of the nerve root was evaluated. Retraction pressure was continuously monitored during the discectomy and the length of the discectomy procedure was measured. Threshold and amplitude of compound muscle action potentials were monitored before and after discectomy. the relationship between intraoperative data on nerve root physiology and postoperative neurologic change was analyzed. Results. Nerve root blood flow was decreased to 18-30% of the initial value under the pressure around 70 g/cm(2). An abrupt decrease in nerve root blood flow was observed even within 1 or 2 mm of retraction distance. The threshold of the nerve root before retraction was minimal in the nerve root of the asymptomatic side, but increased in the affected root demonstrating sensory loss only, and significantly increased in the root showing sensory/motor deficit. Amplitude of compound muscle action potentials evoked by the stimulation at distal from herniated mass was lowest in the nerve root showing sensory/motor deficit. In 4 of 31 patients, high retraction pressure (> 170 g/cm(2)) was required and they showed temporary sensory deterioration after surgery. The length of discectomy procedure in these 4 patients was 14.1 +/- 4.1 minutes, but it was 9.9 +/- 2.7 minutes in the remaining 27 patients.

引用

页码：654 / 659

页数：6

共 12 条

[1]

Bertrand G., The “battered” root problem, Orthop Clin North Am, 6, pp. 305-310, (1975)

[2]

Eiken O., Nabseth D.C., Mayer R.F., Deterling R.A., Limb replantation. II The pathophysiological effects, Arch Surg, 88, pp. 54-65, (1964)

[3]

Fullerton P.M., The effect of ischaemia on nerve conduction in the carpal tunnel syndrome, J Neurol Neurosurg Psychiat, 26, pp. 385-397, (1963)

[4]

Gilliatt R.W., Wilson T.G., Ischaemic sensory loss in patients with peripheral nerve lesions, J Neurol Neurosurg Psychiat, 17, pp. 104-114, (1954)

[5]

Olmarker K., Rydevik B., Holm S., Effects of experimental, graded compression on blood flow in spinal nerve roots: A vital microscopic study on the porcine cauda equina, J Orthop Res, 7, pp. 817-823, (1989)

[6]

Olmarker K., Rydevik B., Holm S., Importance of compression onset rate for degree of impairment of impulse propagation in experimental compression of the porcine cauda equina, Spine, 15, pp. 416-419, (1990)

[7]

Parke W.W., Gamell K., Rothman R.H., Arterial vasucuiarization of the cauda equina, J Bone Joint Surg, 63A, pp. 53-62, (1981)

[8]

Parke W.W., Watanabe R., The intrinsic vasculature of the lumbosacral spinal nerve roots, Spine, 10, pp. 508-515, (1985)

[9]

Rosenern J., Diemer N.H., The risk of cerebral damage during graded brain retractor pressure in the rat, J Neurosurg, 60, pp. 608-611, (1985)

[10]

Rydevik B., Brown M.D., Lundborg G., Pathoanatomy and pathophysiology of nerve root compression, Spine, 9, pp. 7-15, (1984)

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