化学性神经根炎

Chemical radiculitis in lumbar spine

目的研究分析疼痛椎间盘的纤维环破裂与患者下肢放射痛的关系,进而探讨是否存在化学性神经根炎这一临床病理现象。方法临床收集42例单节段椎间盘源性下腰痛伴单侧或双侧下肢放射痛患者,男27例,女15例;年龄19～52岁,平均34.9岁;症状持续至少6个月,平均3年4个月。通过椎间盘造影和其后的CT扫描,分析纤维环撕裂方向与下肢放射痛侧别的关系;行肌电图和运动神经传导速度检查,分析有无神经根损伤,以及其与下肢放射痛的关系。结果腰椎间盘造影时,所有患者显示单水平纤维环破裂且呈现一致性疼痛复制反应,纤维环撕裂方向与下肢放射痛的侧别有显著的正相关性。42例肌电图检查提示神经根损害者32例(76%)。23例单侧下肢放射痛者中17例(74%)存在神经根损害,均为同侧;19例双侧下肢放射痛者中有15例(79%)存在神经根损害。症状侧腓总神经和胫神经运动传导速度较正常侧减慢,差异有统计学意义。结论疼痛椎间盘产生的炎性化学物质通过纤维环全层撕裂漏出并作用于相邻神经根引起神经根损害,可能是化学性神经根炎产生的基本病理生理学机制。

Objective The theory of chemical radiculitis was put forward about 30 years ago, but it has not been proved by clinical study so for. The current study was initiated to assess whether the annular tear in painful disc was the cause of radiating leg pain （radiculopathy） in patients with discogenic low back pain. Methods Forty-two patients with chronic low back pain in single level and shooting leg pain in unilateral or bilateral lower limbs without lumbar disc herniation on CT and MR imaging were treated （age range, 19-52 years; mean age, 34.9 years; 27 males, 15 females）. All patients showed annular disruption and pain reproduction on injection of the contrast during discography at single disc level （not including patients who had two or three levels disc disease）. CT scan was performed to identify the location of annular tears after discography. The examinations of electromyography （EMG） and motor nerve conduction velocity （MCV） were performed in all patients, which were used to analyze the degree of nerve root injury and the relation with radiating leg pain. Results The patients with posterolateral annular disruption in single side mainly presented single lower limb radiation pain, in contrast, the patients with posterolateral annular disruption in two sides or posterior midline annular disruption mainly presented dual lower limb radiation pain. There was a significant positive correlation between the site of annular tear and the side of radiation pain. The examinations of EMG in all 42 cases found that there were abnormal insertional activities such as fibrillation potentials and positive sharp waves in 32 cases （76%）. Of the 23 patients with unilateral lower limb radiation, nerve root lesions were found on the symptomatic side in 17 cases（74%）. Of the 19 cases with bilateral lower limb radiation pain, root lesions were suggested in 15 patients （79%）. The conduction velocities of common peroneal nerve and tibial nerve decreased with a statistically significant difference in symptomatic side compared with normal side. Conclusion Inflammatory chemical mediators and cytokines produced in painful disc leaking into epidural space through annular tear could lead to the injury to adjacent nerve roots, which might be primary pathophysiologic mechanism for the production of chemical radiculitis.