An Gang, Guan Ying, Wan Ran, Wei Tianli, Shi Xu, Liu Jingsong, Huang Tianwen, Liu Kaixuan, Wang Yansong
The First Affiliated Hospital of Harbin Medical University, Nangang, Harbin, P.R. China.
The First Affiliated Hospital of Harbin Medical University, Nangang, Harbin, P. R. China.
Pain Physician. 2021 May;24(3):E289-E297.
Groin pain can be induced by high-level (L1-L2 or L2-L3) lumbar disc herniation. However, 4.1% of patients with lower-level (L4-L5 or L5-S1) lumbar disc herniation also complained of groin pain. The pathomechanism of groin pain occurring due to lumbar disc herniation at and below the L4-5 levels is still unclear.
To investigate the afferent pathways of lower-level lumbar disc herniation induced groin pain. And evaluate the clinical results of transforaminal endoscopic discectomy treatment for discogenic groin pain.
This retrospective observational study used an experimental design (institutional review board: HROH 201-C2-100).
The research took place in the Laboratory Research Center and spine center at The First Affiliated Hospital of Harbin Medical University.
Firstly, 14 adult Wistar rats were randomly divided into 2 groups: control group (the paravertebral sympathetic trunks were preserved) and experimental group (the paravertebral sympathetic trunks were resected). All Wistar rats were intraperitoneally anesthetized, and then 1 (mu)L of fast blue was injected into the dorsal rami of L2 spinal nerves on the right side. Forty hours later, 2 (mu)L of nuclear yellow was injected into the right posterior portion of the L5-L6 intervertebral disc. The L1 and L2 spinal ganglia were sectioned 8 hours later to observe fluorescently double-labeled cells and the effect of paravertebral sympathetic trunk resection. Secondly, 14 adult Wistar rats were anesthetized, and the right posterior portion of the L5-L6 intervertebral disc was electrostimulated to observe potential changes in the genitocrural nerve in the ipsilateral inguinal region. To evaluate the clinical outcomes of transforaminal endoscopic discectomy for the treatment of discogenic groin pain, between September 2015 and May 2017, transforaminal endoscopic discectomy was performed on 30 patients with lower-level discogenic groin pain. Outcomes were analyzed utilizing the visual analog scale, Oswestry disability index, and MacNab Criteria.
The total proportion of cells in the right L1 and L2 spinal ganglia with fast blue/nuclear yellow double labeling was 3.33% and 3.41% (48 and 56), respectively. The number of fluorescently double-labeled cells in the resected paravertebral sympathetic trunk group was significantly less (P < 0.01). Electrical stimulation of the right posterior portion of the L5-L6 intervertebral disc could elicit action potentials in the ipsilateral genitofemoral nerve. All patients were followed for 12 months, and the visual analog scale score at 1 week, 1 month, 3 months, 6 months, and 12 months after the operation was 0.79 ± 0.55, 0.54 ± 0.55, 0.47 ± 0.65, 0.51 ± 0.65, and 0.69 ± 0.55, respectively, showing a significant decrease compared with the preoperative visual analog scale score (P < 0.01). Based on the MacNab scoring system, the effective rate was 100%, and the rate of good and excellent results was 93.3%.
A relatively small number of patients and a short follow-up period.
Discogenic groin pain is transmitted by sympathetic nerves and appears in the area segmentally innervated by the anterior rami of the L1 and L2 spinal nerves. Posterolateral percutaneous transforaminal endoscopic discectomy and radiofrequency thermal annuloplasty are effective minimally invasive alternative treatments for discogenic groin pain.
高位（L1 - L2或L2 - L3）腰椎间盘突出症可引发腹股沟区疼痛。然而，4.1%的低位（L4 - L5或L5 - S1）腰椎间盘突出症患者也主诉有腹股沟区疼痛。L4 - 5及以下节段腰椎间盘突出症所致腹股沟区疼痛的发病机制仍不清楚。
探讨低位腰椎间盘突出症所致腹股沟区疼痛的传入通路。并评估经椎间孔内镜下椎间盘切除术治疗椎间盘源性腹股沟区疼痛的临床效果。
本回顾性观察研究采用实验设计（机构审查委员会：HROH 201 - C2 - 100）。
研究在哈尔滨医科大学附属第一医院实验室研究中心和脊柱中心进行。
首先，将14只成年Wistar大鼠随机分为2组：对照组（保留椎旁交感干）和实验组（切除椎旁交感干）。所有Wistar大鼠均腹腔内麻醉，然后将1μL快蓝注射到右侧L2脊神经后支。40小时后，将2μL核黄注射到L5 - L6椎间盘右后部。8小时后切断L1和L2脊神经节，观察荧光双标记细胞及椎旁交感干切除的效果。其次，将14只成年Wistar大鼠麻醉，电刺激L5 - L6椎间盘右后部，观察同侧腹股沟区生殖股神经的电位变化。为评估经椎间孔内镜下椎间盘切除术治疗椎间盘源性腹股沟区疼痛的临床疗效，2015年9月至2017年5月，对30例低位椎间盘源性腹股沟区疼痛患者实施了经椎间孔内镜下椎间盘切除术。采用视觉模拟评分法、Oswestry功能障碍指数和MacNab标准对结果进行分析。
右侧L1和L2脊神经节中快蓝/核黄双标记细胞的总比例分别为3.33%和3.41%（48个和56个）。切除椎旁交感干组的荧光双标记细胞数量明显减少（P < 0.01）。电刺激L5 - L6椎间盘右后部可诱发同侧生殖股神经的动作电位。所有患者均随访12个月，术后1周、1个月、3个月、6个月和12个月的视觉模拟评分分别为0.79±0.55、0.54±0.55、0.47±0.65、0.51±0.65和0.69±0.55，与术前视觉模拟评分相比显著降低（P < 0.01）。根据MacNab评分系统，有效率为100%，优良率为93.3%。
患者数量相对较少且随访时间较短。
椎间盘源性腹股沟区疼痛由交感神经传导，出现在L1和L2脊神经前支节段性支配的区域。后外侧经皮椎间孔内镜下椎间盘切除术和射频热凝纤维环成形术是治疗椎间盘源性腹股沟区疼痛有效的微创替代治疗方法。
