Clinical and basic studies on the pathophysiology and treatment of the cauda equina and lumbar nerve root compression.

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Basically the symptom derived from the lumbar root lesion can be understood as segmental root syndrome, although, in clinical scenes, atypical cases which present complexed and occasionally nonlogical neurological symptoms are seen.The purpose of this study has been focused on the understanding of these complexed nerve root symptoms. For this study, patients with lumbar canal stenosis who have a tendency to complain multi lumbar nerve roots symptoms, and cases of single nerve root lesion caused by the lumbar disk hernia were examined. Furthermore, cases of low back pain without nerve root sign were also selected for the facet block study.Animal experiments were also carried out to understand the effect of electrical stimulations on the peripheral nerve trunk.Analyzing the effects of lumbar nerve root block using Xylocaine, we found several cases who got relief of main nerve root sign after blocking adjacent nerve root. On the other hand, facet joint blocking affected not only the low b … More ack pain and reffered pain derived from facet joint but also relaxation of tight hamstring muscles.Nerve action potential after stimulating peripheral nerve trunk were recorded from the nerve roots which were regarded as compromised. Some of these nerve roots did not present any pathological nerve action potentials. From these observation, it has been positively indicated that the signals transferred as nociceptive information originating, from nerve endings st facet joint, annulus fibrosis of the disc, etc. are accumulated at dorsal root ganglion or at the dorsal horn of the gray mutter. On coming further nociceptive signals originated from the nerve root or sheath may be summated on the already accumulated nociceptive signals and generate the pain information to send up to the higher central nervous system. This assumption has not been firmly confirmed yet, further investigations are deemed necessary. To understand the effect of electrical stimulation which makes walking distance longer in cases with intermittent claudication, the blood flow in the nerve root was observed in cats during electrical stimulation, although, the elevation of the blow flow was so slight that further involvement of unknown mechanism were indicated. Less