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At least 649 records · Page 36Linked to original sources
PubMed1995

Radiating pain to the lower extremities caused by lumbar disk rupture without spinal nerve root involvement.

PURPOSE: To locate the origin of the pain during lumbar diskography by means of a limited intradiskal injection of a local anesthetic. METHODS: Lumbar diskography by the direct central posterior approach was performed in 235 consecutive patients. In 17 patients, severe and persistent low back pain, with unilateral or bilateral radiation to the lower extremities, was provoked by contrast injection into only one disk. One milliliter of 1% lidocaine was then slowly injected in the center of these disks. RESULTS: A 75% to 100% reduction of the low back pain was experienced by 13 patients, and a 75% to 100% reduction of the radiating pain was experienced by 16 patients within 60 seconds after the intradiskal injection of lidocaine. Radiographs demonstrated radial tears through the entire annulus thickness in 16 of 17 disks. CONCLUSION: Our results suggest that, in some patients with low back pain and unilateral or bilateral radiation to the lower extremities, the pain arises from within the disk. In these cases, pain radiating to the lower limb seems to be a referred type and seems unrelated to direct nerve root compression or irritation by a disk fragment in the epidural space.

Adult↗
PubMed1996

Increased resistance to acute compression injury in chronically compressed spinal nerve roots. An experimental study.

STUDY DESIGN: Nerve conduction velocity was studied in the dog cauda equina subjected to chronic and, 1 week later, additional acute compression. OBJECTIVES: To model the situation of spinal stenosis by first inducing a controlled, chronic compression injury and then to add compression at various pressure levels to the already compressed cauda equina. SUMMARY OF BACKGROUND DATA: Previous models on nerve root and cauda equina compression have analyzed the effects of compression only on noninjured nerves. Clinically, the nerves that are compressed in spinal stenosis already are exposed to chronic compression. METHODS: The cauda equine in the lumbar spine of 10 dogs was first compressed by inflating a plastic balloon, which was placed in the spinal canal, to 10 mm Hg with a viscous substance or leaving it noninflated for control. After 1 week, a second plastic balloon, which was welded together with the first balloon, which had been located in the spinal canal for 1 week, was inflated to 50 or 100 mm Hg for 2 hours with 1.5 hour of recovery, and changes in the nerve conduction velocity were analyzed. Before inflation, baseline data, reflecting the effects of the chronic compression per se, were obtained. RESULTS: After 1 week, the nerve conduction velocity was significantly lower in the compressed cauda equina than in the control series, as an effect of the chronic compression. Additional compression demonstrated that the chronically compressed cauda equina was less susceptible to the compression-induced effects at 100 mm Hg compression. CONCLUSIONS: The data of the present study indicate that chronically compressed nerve roots acquire a tolerance to acute compression, which may indicate that there has been adaptation processes present in the compressed nerve tissue.

Acute Disease↗
PubMedDate not supplied

[Effects of lumbar spinal nerve analgesia on the cardiovascular system].

AIM: The frequency of cardiovascular adverse effects of lumbar paravertebral nerve root infiltration was investigated. METHOD: 117 patients with sciatic pain were included prospectively. 60 % of these suffered from known cardiovascular diseases. In 50 patients, cardiac rhythm was investigated by Holter monitoring. In 100 patients blood pressure, heart rate, respiratory rate and oxygen saturation were registered continuously from 5 minutes before to 15 minutes after the administration of a paravertebral nerve root infiltration by means of a non-invasive monitoring system. RESULTS: A minor rise in systolic and diastolic blood pressure, heart rate and respiratory rate as well as a normalization of these parameters after the nerve root infiltration, were found. These findings were similar for patients with and without pre-existing cardiovascular diseases. No relevant cardiac arrhythmias could be determined. 5 of the 117 patients suffered from presyncope after the nerve root infiltration. These individuals were significantly (p = 0.002) younger than those without presyncope (32.4 +/- 9.3 vs. 55.8 +/- 14.6 years). Presyncope was more frequent during the first treatment with lumbar paravertebral nerve root infiltration in comparison to repeated application of this therapy [4/27 (14.8 %) vs. 1/90 (1.1 %), p = 0.003]. 80 % of the patients who had experienced a presyncope reported a history of similar events. CONCLUSION: According to our findings, cardiovascular monitoring for lumbar paravertebral nerve root infiltrations in the treatment of sciatica does not appear to be required. Patients with a presyncope seem to be characterized by age, first treatment and a history of (pre-)syncopes. In these cases, intravenous fluid substitution might be of help in counteracting vasovagal circulatory reactions.

Anesthetics, Local↗
PubMed1980

Development of the axon membrane during differentiation of myelinated fibres in spinal nerve roots.

Previous studies by a number of workers have shown that the axon membrane in normal mature myelinated fibres is highly differentiated, with the nodal axolemma exhibiting characteristics different to those of the internodal axolemma. However, the development of this axolemmal heterogeneity has not been previously explored. In the present study we used cytochemical methods to examine the development of nodal axolemma during the differentiation of myelinated fibres in rat spinal roots. The staining properties characteristic of normal nodal membrane appear in the axon, at gaps between Schwann cells, before the development of mature compact myelin or well defined paranodal axon--Schwann cell specializations close to the region of nodal axolemmal differentiation. These results are consistent with the hypothesis that the axon membrane differentiates into nodal and internodal regions before, or early in the process of, myelination, and suggest that the differentiation of the axon membrane may provide a signal demarcating the region to be covered by the myelin-forming cell.

Animals↗
PubMed1983

[Numbering of the dorsal spinal nerve roots in man from the 12th thoracic nerve to the coccygeal nerve].

A bilateral study for locating the dorsal root filaments of specific nerves was accomplished from the twelfth thoracic to the coccygeal level and this using 26 fetal and 8 adult specimens. After laminectomy from the thoracic to coccygeal levels, incision of the dural sac permitted visualisation of the dorsal root filaments, the successive rootlets corresponding to each segmental level (T12 to Co1 ) were counted with the aid of a binocular microscope where they penetrated the spinal medulla at the posterior sulcus. Statistical evaluation shows that for each dorsal nerve the average number of root filaments is greater on the right compared with the left. Numbering the dorsal nerve root filaments in the cephalo -caudal direction allows to assert with 99% probability up to the L5 level and with 95% probability up to the S1 level that one is at a given spinal level of the respective segmental range; caudal-cephalic direction numbering permits to affirm with 99% probability up to the S1 level and 95% probability up to the L4 level that one is at a given spinal level of the respective segmental range.

Fetus↗
PubMed1994

Melanoma arising in a cervical spinal nerve root: report of a case with a benign course and malignant features.

A 20-year-old caucasian woman with a 5-year history of right arm, neck, and back pain sought treatment when an automobile accident (4 months before admission) exacerbated her pain. Magnetic resonance imaging revealed an intra- and extradural mass compressing the spinal cord at the C5-C6 level. It also extended into and widened the neural foramen, mimicking a neurofibroma. A single cafe-au-lait spot was discovered in the inguinal region. A two-staged surgical resection was performed on an apparent hemorrhagic C6 nerve root mass. The mass exhibited diagnostic features of a malignant melanoma histologically, immunocytochemically, and ultrastructurally. A search for a primary lesion outside the nervous system or other metastases during an 8-year period from the onset of symptoms has been negative. The patient's chronic history, evidence of neural foraminal enlargement, and the absence of other malignant melanoma lesions or subsequent metastases indicates that this lesion may be a primary melanoma of the nerve root with a benign course.

Adult↗
PubMed2002

[Comparison of three neuro-tracing techniques for identification of the sciatic spinal nerve origin in mice].

To identify sensory and motor neurons associated with the sciatic nerve in adult mice, three methods for applying fluorescent tracers (Fluorogold and Dil) were investigated: direct application, intraneural injection and impregnation of a sectioned nerve in a silicone chamber. Most accurate localization of the neurons on the dorsal root ganglia and spinal cord was accomplished by introducing the proximal stump of a transected sciatic nerve into a silicone chamber, filled with tracers and then decalcifying the tissue. Fluorogold was an effective tracing agent, in contrast to Dil, which was not. In addition to associations with cephalic ganglia L4, L5 and L6, as seen in rats, contributory neurons to the sciatic nerve were located in other ganglia in the mouse. These findings show that the silicone chamber-tissue decalcification technique is a viable tool for obtaining comparative neuroanatomical information in the mouse model.

Animals↗
PubMed2004

Targeting the spinal nerve via a double-needle, transforaminal approach in failed back surgery syndrome: demonstration of a technique.

Spinal surgery, particularly spinal fusion surgery, alters the anatomy of the spine and hence, may increase the difficulty of performing an interventional spine procedure. Transforaminal epidural procedures have gained popularity as an alternative to interlaminar epidural steroids in the management of radicular pain syndromes. Patients with failed back surgery syndrome are often excluded or represent a minor subset in many clinical studies evaluating the efficacy of transforaminal procedures. When included, however, patients with FBSS have typically undergone laminectomies or microdiscectomies: these procedures are less likely to violate the foraminal space in the spine compared to fusion surgery. We describe the specific details of a transforaminal approach to the epidural space/spinal nerve in a patient with a posterolateral and posterior interbody fusion.

Journal Article↗
PubMed1998

Pathogenesis of sciatic pain: role of herniated nucleus pulposus and deformation of spinal nerve root and dorsal root ganglion.

The basic pathophysiologic mechanisms related to disc herniation and sciatica are poorly understood. Recently it was demonstrated that nucleus pulposus from an intervertebral disc could induce structural and functional changes in adjacent nerve roots when applied epidurally, however, it is not known if such changes are painful. In a model for inducing disc herniation in the rat, we found that puncture of a lumbar disc with subsequent herniation of nucleus pulposus without nerve root compression, or chronic displacement of the 4th lumbar nerve root and ganglion, did not individually induce significant changes in thresholds for mechanical or thermal stimulation compared to sham-operated animals. However, the combination of disc puncture and displacement induced a reduction of the threshold for thermal stimulation, indicating hyperalgesia, that was present 2 days after surgery and gradually recovered during a 14-day period. These data and the associated description of this new model for experimental disc herniation may increase our understanding of the pathophysiologic events leading to sciatica and help in evaluating new modalities for diagnosis and treatment of disc herniation and sciatica.

Animals↗
PubMed2003

Clinical importance of ligamentous and osseous structures in the cervical uncovertebral foraminal region.

The vertebral artery, cervical spinal nerves, spinal nerve roots, and the bony and ligamentous tissue related to the cervical vertebrae are structures whose anatomy determines the path of a surgical approach. Defining the anatomy and, in particular, determining the precise location of vulnerable structures at the intervertebral foramen and the uncovertebral foraminal region (UVFR), a region defined by the uncinate process anteriorly, the facet joint posteriorly and the foramen transversarium laterally, has critical significance when selecting the safest surgical approach. We studied the anatomy of the vertebral artery, cervical spinal nerves, and spinal nerve roots within the UVFR in six cadaver specimens. We also obtained measurements of bony structures in 35 dry cervical vertebral columns, from C3-C7. The uncinate process (UP) projects superiorly from the posterolateral aspect of each cervical vertebral body, except for the first and second vertebrae. Because the posterior part of the UP lies adjacent to the vertebral artery, spinal nerve, and spinal nerve roots, its resection creates sufficient space to decompress these structures directly. The posterolateral surface of the UP is covered by ligamentous tissue that originates from the posterior longitudinal ligament and protects the neural and vascular structures during their decompression in the UVFR.

Cervical Vertebrae↗
PubMed1989

Intracellular transport and neuronal activation of phospholipid and glycoprotein synthesis during axonal regeneration of cranio-spinal nerves.

In the present work, the hypothesis that the increased rapid intracellular transport of newly-synthesized material along the axons of a regenerating system is sustained by an alteration of the transport of proteolipid complexes through subcellular compartments of a neuronal cell body was tested by a biochemical methodology. The motoneurons of spinal cord ventral horn, 4 wk after unilateral lesion (crush) of cervico-thoracic nerves of the rabbit at the level of brachial plexus, were chosen as the model system of regeneration. A time-staggered procedure of in vivo and in vitro double labeling with metabolic precursors, such as [3H]-choline, [14C]-choline, [3H]-fucose, and [14C]-fucose, was used. Subcellular fractions (RER, SER, Golgi apparatus, and plasma membranes) of ventral horn tissue, taken from spinal cord hemisections (regenerating and contralateral side), were further isolated. Twenty-eight days after axotomy, we did not observe any change of intracellular transport kinetics (14C/3H ratio) of newly-synthesized choline-phospholipids and glycoproteins in regenerating motoneurons compared to controls. However, associated with regenerating phenomenon in Golgi apparatus, we observed an increase of labeled choline-phospholipid and glycoprotein material that could contribute to the increased fast axonal transport and delivery of membrane proteolipid complexes to plasma membrane and axonal compartments. The increase of glycoprotein labeling was more pronounced in the SER portion (vesicles and elements of smooth membranes). This result is in favor of the hypothesis that membrane-bound proteins are transported from the Golgi to the axon through the perikaryal SER.

Animals↗
PubMed1988

High spinal nerve block for large bowel anastomosis. A prospective study.

In a randomized, prospective study of patients undergoing large bowel anastomosis, 47 patients received subarachnoid block and light general anaesthesia, and 51 received conventional general anaesthesia with intermittent positive pressure ventilation. Anastomotic dehiscence occurred in 17.0% of the spinal group and in 17.6% of patients anaesthetized by the conventional technique. Blood loss was significantly (P less than 0.001) lower in the spinal group than in the general anaesthesia group. Blood transfusion was required in 10.6% of patients in the spinal group and 21.6% of patients receiving general anaesthesia.

Adult↗