The basic wave pattern of lumbar root potentials and clinical application

我们常规应用形态学检查辅助临床检查对腰神经根病进行客观诊断。然而，我们经常遇到临床病例，其中临床检查诊断的水平不符合脊髓造影的结果。在这些情况下，需要进行电生理检查。人们希望设计出更直接的电生理检查，使我们能够记录神经系统的电活动，揭示神经传导的实际状态。这种检查的要求如下：1）容易在门诊诊所的适用性，2）执行风险最小，和3）选择性记录传入和传出神经volleys.The调查进行了15例腰椎间盘突出症和椎管狭窄症，以及5名神经正常的成年志愿者。用表面电极刺激胫神经或腓神经， 关于我们 在L5/S1、L4/5和L3/4硬膜外腔记录t电位。用SRP同步监测诱发EMG反应，以引起比目鱼肌H和M反应的强度刺激胫神经，从硬膜外电极记录两种不同波幅的电位。观察了SRP与相应的H反射和M反应之间的振幅关系。在LDH和LSS的前、后节段，观察到1）阳性反应，2）多相波，3）病理性低波幅。15例中有11例在前根或后根出现多相电位和（或）正电位。其余4例未见病理波。但用定量方法估计低幅值，其中3例表现为病理性低幅值。我们认为目前的审查令人满意，尽管仍存在一些问题。少

We routinely use the morphological examination for an objective deagnosis assisting clinical examinations in lumbar root radicuropathy. We,however, not infrequently encounter the clinical cases in which the level diagnosed by clinical examination does not coincide the result of myelography. In these cases electrophysiological examination are needed. It is desirable to devise more direct electrophysiological examinations which allow us to record electrical activities of the nervous system revealing the actual state of nerve conduction. Requirements for such examination would be as follows; 1) easy applicability in the out-patient clinic, 2) minimal risk on execution, and 3) selective recording of the afferent and efferent nerve volleys, if possible.The investigation was carried out on 15 patients with the lumbar disc herniationand the spinal stenosis, and also five neurologically normal adult volunteers. Tibial or peroneal nerve was stimulated with the surface electrodes, and lumbar roo … More t potential was recorded in the epidural space L5/S1,L4/5 and L3/4. Evoked EMG responses were monitored simultaneously with SRP.Two kinds of potentials with aifferent latencies were recorded from the epidural electrodes by stimulation of the tibial nerve with the intensity evoking both H and M responses in the soleus muscle. The relationship of the amplitude between SRP and the corresponding H-reflex and M-response was examined. From these result the liminal stimulation at the M-threshold would allow us to monitor the conduction of the posterior root and the supra maximal stimulation of the M-response do that in anterior root.In posterior and anterior of LDH and LSS, 1)positivisation, 2)polyphasic wave and 3)pathological low amplitude were examined. 11 cases of the examined 15 cases had the positivisation and/or polyphasic potentials in the posterior or anterior root. The pathological waves were not observed in the remaining 4 cases. But 3 of those 4 cases showed the pathological low amplitude by using the quantitative method for estimating the low amplitude. We found the present examination satisfactory despite some problems still remained. Less