Tsuji H, Tamaki T, Itoh T, Yamada H, Motoe T, Tatezaki S, Noguchi T, Takano H
Spine (Phila Pa 1976). 1985 Jan-Feb;10(1):72-82. doi: 10.1097/00007632-198501000-00012.
Extensive fundamental and clinical investigations have been performed concerning redundant nerve roots (RNR) and the pathogenesis of cauda equina claudication (CEC) in degenerative lumbar canal stenosis (DLCS). These investigations consisted of (1) anatomic observations on RNR in 117 fixed cadaveric specimens, (2) myelographic study in 117 patients with or without DLCS, (3) operative observation on neural elements with special reference to the cauda equina in 56 DLCS patients (including a postoperative follow-up), and (4) electrophysiologic tests using spinal cord action potential recording under walking load preoperatively and intraoperative measurement of nerve conduction velocity of RNR. The RNR have neuronal losses resulting from a longer duration stenosis that suggests a sort of friction neuritis. Complicated factors contribute to the pathogenesis of CEC and the development of root gripping, such as the magnitude of RNR, the extent of the stenosis, a narrowed sac, age-dependent axial shortening of the spinal canal, and dynamic or postural factors. In cases with severe RNR, satisfactory operative results can be obtained only after thorough decompression with dural incision.
针对退行性腰椎管狭窄症（DLCS）中多余神经根（RNR）及马尾神经间歇性跛行（CEC）的发病机制，已经开展了广泛的基础和临床研究。这些研究包括：（1）对117个固定尸体标本中的RNR进行解剖观察；（2）对117例有或无DLCS的患者进行脊髓造影研究；（3）对56例DLCS患者（包括术后随访）的神经结构进行手术观察，特别关注马尾神经；（4）术前在行走负荷下使用脊髓动作电位记录进行电生理测试，并在术中测量RNR的神经传导速度。RNR存在因狭窄持续时间较长导致的神经元丢失，提示一种摩擦性神经炎。复杂因素促成了CEC的发病机制和神经根卡压的发展，如RNR的程度、狭窄范围、骶管狭窄、年龄相关的椎管轴向缩短以及动态或姿势因素。在RNR严重的病例中，只有在切开硬脊膜进行彻底减压后才能获得满意的手术效果。
