Massie Jennifer B, Huang Bill, Malkmus Shelley, Yaksh Tony L, Kim Choll W, Garfin Steven R, Akeson Wayne H
Department of Orthopaedics, Veterans Administration San Diego Health Care System and University of California, 3350 La Jolla Village Drive, San Diego, CA 92161, USA.
J Neurosci Methods. 2004 Aug 30;137(2):283-9. doi: 10.1016/j.jneumeth.2004.02.036.
Chronic low back pain with sciatica complicating post laminectomy surgery is poorly understood. It is likely that some aspects of persistent pain of the syndrome results from spinal facilitation in which there is lowering of pain excitation levels. A small animal preclinical model is needed that mimics the clinical condition to permit detailed studies of the underlying altered neurochemistry of the sensory pathways. We propose herein a rat laminectomy model containing the elements required for study of the neurobiology of the condition. The model consists of a surgical laminectomy that includes L5 spinal nerve manipulation and disc injury, elements necessarily employed in human disc herniation surgery. At 8 weeks post laminectomy the proposed model demonstrates paraspinous muscle spasm, tail contracture, behavioral pain behavior, tactile allodynia, epidural and nerve root scarring, and nerve root adherence by scar to the underlying disc and adjacent pedicle. Two underlying pain facilitation states are invoked in the clinical condition: (1) an inflammatory state required to achieve wound healing; and (2) a nerve injury state resulting from nerve manipulation and subsequent epidural scarring, spinal nerve scarring, and spinal nerve tethering to the adjacent disc and pedicle. Both pain facilitation states are active in the model.
腰椎板切除术后并发坐骨神经痛的慢性下腰痛目前仍未得到充分理解。该综合征持续性疼痛的某些方面可能源于脊髓易化作用,即疼痛兴奋水平降低。需要一个小动物临床前模型来模拟临床状况,以便对感觉通路潜在的神经化学改变进行详细研究。我们在此提出一种大鼠腰椎板切除模型,该模型包含研究该病症神经生物学所需的要素。该模型包括手术性腰椎板切除术,其中包括L5脊神经操作和椎间盘损伤,这些都是人类椎间盘突出症手术中必然采用的要素。在腰椎板切除术后8周,该模型表现出椎旁肌痉挛、尾部挛缩、行为性疼痛行为、触觉异常性疼痛、硬膜外和神经根瘢痕形成,以及神经根通过瘢痕与下方椎间盘和相邻椎弓根粘连。临床状况引发了两种潜在的疼痛易化状态:(1)实现伤口愈合所需的炎症状态;(2)由神经操作以及随后的硬膜外瘢痕形成、脊神经瘢痕形成和脊神经与相邻椎间盘和椎弓根的束缚所导致的神经损伤状态。这两种疼痛易化状态在该模型中均处于活跃状态。