Kobayashi M
Nihon Seikeigeka Gakkai Zasshi. 1985 Jan;59(1):27-38.
In the present paper, the author has attempted to show the origin of the spinal cord potential in man and to establish a practical technique for evaluating the function of the spinal cord and root. In 80 patients with spinal cord and root lesions rectangular current electrical stimulation of 0.1-0.2 msec duration and 1-3 Hz in frequency was given to the median nerve. Basic wave shape of spinal cord potential recorded from epidural space showed the two components which were the biphasic spike wave (the 1st potential) and the negative slow wave (the 2nd potential). The 1st potential elicited by stimulation of the median nerve at the elbow had a duration of 2.3 +/- 0.2 msec and negative peak latency of 7.2 +/- 0.3 msec. The 2nd potential under the same conditions had a duration of 4.1 +/- 1.3 msec and negative peak latency of 9.6 +/- 0.5 msec. The 1st potential elicited by stimulation of the median nerve at the wrist had a duration of 1.9 +/- 0.2 msec and negative peak latency of 10.4 +/- 0.7 msec. The 2nd potential under the same conditions had a duration of 6.2 msec and negative peak latency of 12.2 +/- 0.6 msec. According to the position of leading electrode, the two components changed independently in amplitude. Amplitude of the 2nd potential obtained from the midline of the epidural space was relatively larger than that from facet joints. Evoked spinal cord potentials obtained from the lateral border of facet joints revealed marked 1st potential. Recovery curves of the two components showed that the 1st potential quickly recovered to 100% in amplitude in 10 msec, but that the 2nd potential recovered slowly to only 70% in 100 msec. In cases of root lesions, spinal cord potentials revealed positivity of the 1st potential, polyphasic wave or disappearance of wave shape. In cases of spinal cord lesion, normal 1st potentials and flattening of the 2nd potentials were seen. The author has confirmed that the origin of the 1st potential in man is in primary afferent fiber and that the 2nd potentials in man reflect activity of spinal cord and are excited by synaptic relay. It is highly possible that the cervical root lesion can be differentiated from spinal cord lesion by this method.
在本文中，作者试图揭示人类脊髓电位的起源，并建立一种评估脊髓和神经根功能的实用技术。对80例脊髓和神经根病变患者的正中神经给予持续时间为0.1 - 0.2毫秒、频率为1 - 3赫兹的矩形电流电刺激。从硬膜外间隙记录到的脊髓电位的基本波形显示有两个成分，即双相棘波（第1电位）和负向慢波（第2电位）。在肘部刺激正中神经引出的第1电位，持续时间为2.3±0.2毫秒，负向峰值潜伏期为7.2±0.3毫秒。在相同条件下的第2电位，持续时间为4.1±1.3毫秒，负向峰值潜伏期为9.6±0.5毫秒。在腕部刺激正中神经引出的第1电位，持续时间为1.9±0.2毫秒，负向峰值潜伏期为10.4±0.7毫秒。在相同条件下的第2电位，持续时间为6.2毫秒，负向峰值潜伏期为12.2±0.6毫秒。根据引导电极的位置，这两个成分的幅度独立变化。从硬膜外间隙中线获得的第2电位的幅度相对大于从关节突关节获得的幅度。从关节突关节外侧缘获得的诱发脊髓电位显示出明显的第1电位。这两个成分的恢复曲线表明，第1电位在10毫秒内幅度迅速恢复到100%，但第2电位在100毫秒内缓慢恢复到仅70%。在神经根病变的病例中，脊髓电位显示第1电位阳性、多相波或波形消失。在脊髓病变的病例中，可见正常的第1电位和第2电位变平。作者已证实人类第1电位的起源在于初级传入纤维，而人类的第2电位反映脊髓的活动并由突触中继激发。通过这种方法很有可能区分颈神经根病变和脊髓病变。
