Hirshberg R M, Al-Chaer E D, Lawand N B, Westlund K N, Willis W D
Department of Neurosurgery, St. Joseph Hospital, Houston, TX, USA.
Pain. 1996 Oct;67(2-3):291-305. doi: 10.1016/0304-3959(96)03127-2.
The present report provides evidence that axons in the medial part of the posterior column at T10 convey ascending nociceptive signals from pelvic visceral organs. This evidence was obtained from human surgical case studies and histological verification of the lesion in one of these cases, along with neuroanatomical and neurophysiological findings in animal experiments. A restricted lesion in this area can virtually eliminate pelvic pain due to cancer. The results remain excellent even in cases in which somatic structures of the pelvic body wall are involved. Following this procedure, neurological testing reveals no additional neurological deficit. There is no analgesia to pinprick stimuli applied to the body surface, despite the relief of the visceral pain. Since it is reasonable to attribute the favorable results of limited midline myelotomies to the interruption of axons of visceral nociceptive projection neurons in the posterior column, we have performed experiments in rats to test this hypothesis. The results in rats indicate that the dorsal column does indeed include a nociceptive component that signals pelvic visceral pain. The pathway includes neurons of the postsynaptic dorsal column pathway at the L6-S1 segmental level, axons of these neurons in the fasciculus gracilis, and neurons of the nucleus gracilis and the ventral posterolateral nucleus of the thalamus.
本报告提供了证据，表明胸10水平后柱内侧的轴突传递来自盆腔内脏器官的上行伤害性信号。该证据来自人体手术病例研究以及其中一例病例病变的组织学验证，同时还有动物实验中的神经解剖学和神经生理学发现。该区域的局限性损伤实际上可消除癌症引起的盆腔疼痛。即使在盆腔体壁的躯体结构受累的情况下，结果仍然非常好。进行此手术后，神经学检查未发现额外的神经功能缺损。尽管内脏疼痛得到缓解，但对体表施加的针刺刺激没有镇痛作用。由于将有限的中线脊髓切开术的良好结果归因于后柱内脏伤害性投射神经元轴突的中断是合理的，因此我们在大鼠中进行了实验以验证这一假设。大鼠实验结果表明，背柱确实包含一个发出盆腔内脏疼痛信号的伤害性成分。该通路包括腰6 - 骶1节段水平的突触后背柱通路神经元、这些神经元在薄束中的轴突以及薄束核和丘脑腹后外侧核的神经元。
