Cook A W, Nathan P W, Smith M C
Brain. 1984 Jun;107 ( Pt 2):547-68. doi: 10.1093/brain/107.2.547.
Twenty-five cases of commissural myelotomy were studied. Representative cases are reported, including a histological examination of the lesion in one. Although the purpose of the operation is to produce a cuirass of loss of pain sensibility by dividing the spinothalamic and spinoreticulothalamic fibres as they decussate in the anterior commissure of the cord, this result is not always obtained. Whether or not the expected sensory loss is obtained, the chronic pain for which the operation is performed can be relieved. Sensibility tends to return towards normal after myelotomy. Even with substantial recovery of sensory loss, the pain for which the operation was performed can remain absent. Asymmetrical sensory loss may be produced by the operation; reasons for this are suggested. Differences between the results of commissural myelotomy and anterolateral cordotomy are discussed. Unlike the results of anterolateral cordotomy, which can be accounted for on the basis of known anatomy, the results of commissural myelotomy are inexplicable on present anatomical knowledge. Attention is drawn to the results of myelotomy reported originally by Hitchcock and confirmed by other neurosurgeons in which a short myelotomy incision in the upper cervical cord caused loss of pain over a vast region of the body. The difficulty in explaining the patterns of sensory loss in these cases is discussed. The literature on pathways alternative to the spinothalamic and spinoreticulothalamic is reviewed. It is argued that the central incision cannot cause relief of pain merely by cutting an afferent pathway, and it is suggested that this lesion blocks impulses entering into, in, or leaving the spinothalamic complex. The accurate localization of pinprick and thermal stimuli via the spinothalamic tract is demonstrated.
对25例脊髓联合切开术病例进行了研究。报告了具有代表性的病例，包括其中1例病变的组织学检查。尽管该手术的目的是通过切断脊髓丘脑束和脊髓网状丘脑束在脊髓前连合交叉处的纤维，以形成一个痛觉丧失的“铠甲”，但并非总能达到这一效果。无论是否获得预期的感觉丧失，该手术所针对的慢性疼痛均可得到缓解。脊髓切开术后感觉往往会趋于恢复正常。即使感觉丧失有显著恢复，手术所针对的疼痛仍可能消失。该手术可能导致不对称的感觉丧失，并提出了相关原因。讨论了脊髓联合切开术与脊髓前外侧切开术结果的差异。与基于已知解剖结构可以解释的脊髓前外侧切开术结果不同，脊髓联合切开术的结果根据目前的解剖学知识无法解释。提请注意希区柯克最初报告并经其他神经外科医生证实的脊髓切开术结果，即上颈段脊髓的短脊髓切开术切口可导致身体大片区域的痛觉丧失。讨论了解释这些病例中感觉丧失模式的困难。回顾了关于脊髓丘脑束和脊髓网状丘脑束以外的传导通路的文献。有人认为，中央切口不能仅仅通过切断传入通路来缓解疼痛，并提出该病变会阻断进入、位于或离开脊髓丘脑复合体的冲动。展示了通过脊髓丘脑束对针刺和热刺激的准确定位。
