Friehs G M, Schröttner O, Pendl G
Department of Neurosurgery, Karl Franzens Universität Graz, Austria.
J Neurosurg. 1995 Jul;83(1):8-12. doi: 10.3171/jns.1995.83.1.0008.
The lateral spinothalamic tract, located in the anterolateral quadrant of the white matter of the spinal cord, is one of the most important structures in transmitting pain within the central nervous system. It has been known for almost a century that destruction of fibers in this tract results in analgesia contralateral to the lesion. The effectiveness and clinical importance of interruption of the lateral spinothalamic tract has been proven in many studies. Today cordotomies are still a useful neurosurgical treatment modality, especially when pain can no longer be sufficiently controlled by analgesic drugs. Although analgesia on the contralateral side is the desired effect, one must also expect to cause disturbance in temperature sensation when performing a cordotomy. The authors' observations showed that after a cordotomy the dermatome level of analgesia can be variable within certain limits, which is in accordance with the literature. Surprisingly, however, the loss of temperature sensation may differ significantly from the loss of pain sensation. It was also found to be possible to perform a successful cordotomy without altering the sensation of temperature at all. This indicates that pain and temperature sensations may be conducted via separate pathways. Possible mechanisms underlying this phenomenon are discussed.
脊髓丘脑侧束位于脊髓白质的前外侧象限，是中枢神经系统内传递疼痛的最重要结构之一。近一个世纪以来，人们已经知道该束纤维的破坏会导致病变对侧的镇痛。许多研究已经证明了切断脊髓丘脑侧束的有效性和临床重要性。如今，脊髓切开术仍然是一种有用的神经外科治疗方式，尤其是当疼痛无法再通过镇痛药充分控制时。虽然对侧镇痛是预期效果，但在进行脊髓切开术时也必须预料到会引起温度感觉障碍。作者的观察表明，脊髓切开术后，镇痛的皮节水平在一定范围内可能会有所不同，这与文献一致。然而，令人惊讶的是，温度感觉的丧失可能与痛觉的丧失有显著差异。还发现有可能在完全不改变温度感觉的情况下成功进行脊髓切开术。这表明痛觉和温度觉可能通过不同的通路传导。本文讨论了这一现象潜在的可能机制。
