Yabuki S, Kawaguchi Y, Nordborg C, Kikuchi S, Rydevik B, Olmarker K
Department of Orthopaedics, Sahlgren University Hospital, Sweden.
Spine (Phila Pa 1976). 1998 Nov 15;23(22):2383-9; discussion 2389-90. doi: 10.1097/00007632-199811150-00004.
Application of autologous nucleus pulposus on nerve roots and treatment with local application of lidocaine in the pig.
Studies of the effects of lidocaine on nucleus pulposus-exposed nerve roots.
Nerve root infiltration may improve radicular symptoms beyond the pharmacologic duration of local anesthetics, but the mechanisms for this effect are not known.
Nucleus pulposus was harvested from a lumbar disc and placed onto the sacrococcygeal cauda equina in pigs. In Series 1, early lidocaine treatment of nucleus pulposus-induced nerve root injury, pigs received 2% lidocaine (n = 5) or saline (n = 5) before and after surgery. Nerve conduction velocity and histologic appearance were studied after 3 days. In Series 2, delayed lidocaine treatment of nucleus pulposus-induced nerve root injury, after 7 days 2% lidocaine was administered epidurally to nucleus pulposus-exposed (n = 4) and -nonexposed (n = 4) nerve roots. Nerve conduction velocity, muscle action potentials, and histologic appearance were assessed.
In Series 1, early treatment with lidocaine limited the reduction in nerve conduction velocity. The epidural inflammation was less in lidocaine treated animals. In Series 2, nerve conduction velocity was lower in nucleus pulposus-exposed animals than in nonexposed animals. The initial reduction of nerve conduction velocity and muscle action potential was similar between the groups, but the recovery of muscle action potential was slower and less complete in nucleus pulposus-exposed nerve roots. There was minimal histologic nerve injury in both series and in both protocols.
Early treatment with lidocaine may reduce nucleus pulposus-induced nerve root injury. Lidocaine induced a delayed recovery in nerve roots exposed to nucleus pulposus. Further studies are needed to clarify the therapeutic effects of nerve root infiltration and the pathophysiology of nucleus pulposus-induced nerve root injury.
自体髓核在猪神经根上的应用及利多卡因局部应用治疗。
研究利多卡因对暴露于髓核的神经根的影响。
神经根浸润可改善神经根症状，且持续时间超过局部麻醉药的药理作用时间，但其作用机制尚不清楚。
从腰椎间盘获取髓核并置于猪的骶尾部马尾神经上。在系列1中，对髓核诱导的神经根损伤进行早期利多卡因治疗，猪在手术前后接受2%利多卡因（n = 5）或生理盐水（n = 5）。3天后研究神经传导速度和组织学表现。在系列2中，对髓核诱导的神经根损伤进行延迟利多卡因治疗，7天后对暴露于髓核的神经根（n = 4）和未暴露的神经根（n = 4）硬膜外给予2%利多卡因。评估神经传导速度、肌肉动作电位和组织学表现。
在系列1中，早期利多卡因治疗限制了神经传导速度的降低。利多卡因治疗的动物硬膜外炎症较轻。在系列2中，暴露于髓核的动物神经传导速度低于未暴露的动物。两组之间神经传导速度和肌肉动作电位的初始降低相似，但暴露于髓核的神经根中肌肉动作电位的恢复较慢且不完全。在两个系列和两种方案中，组织学神经损伤均最小。
早期利多卡因治疗可能减轻髓核诱导的神经根损伤。利多卡因导致暴露于髓核的神经根恢复延迟。需要进一步研究以阐明神经根浸润的治疗效果及髓核诱导的神经根损伤的病理生理学。
