Indahl A, Kaigle A, Reikerås O, Holm S
Spine Clinic, Ostfold Central Hospital, Fredrikstad, Norway.
Spine (Phila Pa 1976). 1995 Dec 15;20(24):2652-8. doi: 10.1097/00007632-199512150-00006.
In this study, a porcine model was used to study whether a nerve reaction in the anulus fibrosus of a lumbar disc or in a facet joint capsule could cause a muscular response in the multifidus musculature.
To determine if there is an interrelationship between the intervertebral disc and facet joint innervation and the multifidus musculature as a possible pain mechanism.
The innervation of the anulus fibrosus of the intervertebral disc and the capsule of the facet joint is well described in the literature, although the functions of these nerves are poorly understood. An interrelationship between this innervation and the paraspinal musculature has not been previously described.
Fifteen adult pigs were used to measure the electromyographic response in the multifidus musculature to electrical stimulation of the lateral region of the disc anulus and the facet joint capsule in the L1-L2 motion segment. Motor unit action potentials were recorded using three sets of bipolar needle electrodes placed into the deepest fascicles of the multifidus, bilateral to the L2, L3, and L4 spinous processes. The effect of lidocaine injection into the facet joint and subperiosteal muscle detachment on the electromyographic response were studied.
Stimulation of the disc anulus fibrosus induced reactions in the multifidus on multiple levels and on the contralateral side, whereas stimulation of the facet joint capsule induced reactions predominantly on the same side and segmental level as the stimulation. Introduction of lidocaine into the facet joint resulted in a significantly reduced electromyographic response to either stimulation, with the most drastic reduction seen when stimulating the facet joint capsule. Subperiosteal detachment of the paraspinal muscles prevented any muscular response.
Stimulation of the disc and the facet joint capsule produced contractions in multifidus fascicles. The clinical implications are that there may be interactive responses between injured or diseased structures, i.e., disc or facet joints, and the paraspinal musculature. Activation of the multifidus muscles may have a stabilizing effect, constraining the motion of the lumbar spine. Longstanding muscular contraction may produce ischemic conditions and may be a potential source of pain.
在本研究中，使用猪模型来研究腰椎间盘纤维环或小关节囊中的神经反应是否会引起多裂肌的肌肉反应。
确定椎间盘与小关节神经支配和多裂肌之间是否存在相互关系，作为一种可能的疼痛机制。
尽管对这些神经的功能了解甚少，但椎间盘纤维环和小关节囊的神经支配在文献中有详细描述。此前尚未描述这种神经支配与椎旁肌肉组织之间的相互关系。
使用15只成年猪测量多裂肌对L1-L2运动节段椎间盘外侧区域和小关节囊进行电刺激时的肌电图反应。使用三组双极针电极记录运动单位动作电位，电极放置在多裂肌最深层肌束中，位于L2、L3和L4棘突双侧。研究了向小关节注射利多卡因和骨膜下肌肉分离对肌电图反应的影响。
刺激椎间盘纤维环在多个层面和对侧的多裂肌中诱发反应，而刺激小关节囊主要在与刺激同侧和节段水平诱发反应。向小关节注射利多卡因导致对任何一种刺激的肌电图反应显著降低，刺激小关节囊时降低最为明显。椎旁肌骨膜下分离可阻止任何肌肉反应。
刺激椎间盘和小关节囊可使多裂肌束收缩。临床意义在于，受损或患病结构（即椎间盘或小关节）与椎旁肌肉组织之间可能存在相互反应。多裂肌的激活可能具有稳定作用，限制腰椎的运动。长期的肌肉收缩可能会产生缺血状态，可能是疼痛的潜在来源。
