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

腰神经根病变的症状基本上可以理解为节段性根综合征，但在临床场景中，也会看到表现出复杂的、偶尔非神经系统症状的非典型病例。本研究的目的是了解这些复杂的神经根症状。本研究对有多神经根症状倾向的腰椎管狭窄症患者和腰椎间盘突出症引起的单根神经根病变患者进行了检查。通过动物实验了解电刺激对周围神经干的影响，分析西洛卡因腰神经根阻滞的效果，发现有几例患者在阻断邻近神经根后，主神经根体征得到缓解。另一方面，小关节阻塞不仅影响低b…。更多的背痛和牵涉性疼痛来自小关节，但也有紧绷的腿肌松弛。刺激周围神经干后，从被认为受损的神经根记录到神经动作电位。部分神经根未出现任何病理神经动作电位。这些观察结果表明，来自小关节神经末梢、椎间盘纤维环等伤害性信息传递的信号聚集在背根神经节或灰质鸣叫的背角。在进一步到来时，来自神经根或鞘的伤害性信号可能被累加到已经积累的伤害性信号上，并产生疼痛信息，向上发送到高级中枢神经系统。这一假设尚未得到证实，认为有必要进行进一步调查。为了解电刺激使间歇性跛行患者步行距离延长的作用，观察了猫在电刺激过程中神经根血流量的变化，但血流量升高幅度很小，提示可能有进一步的机制参与。较少

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