METHODS: We present 6 consecutive patients (7 sides) with intractable LBP who underwent successful MCN neurectomy. Their symptom duration ranged from 6 to 96 months (average 47.3 months); the follow-up period ranged from 6 to 17 months (average 11.7 months). The surgical outcomes were evaluated using the numerical rating scale (NRS) for LBP and the Roland-Morris Disability Questionnaire (RDQ) score. The resected MCNs underwent neuropathological analysis.
RESULTS: Postoperatively, all 6 patients reported immediate LBP amelioration; their NRS and RDQ scores were improved significantly. Pathological study of the 7 resected nerves showed that the myelinated fiber density was decreased in 6 nerves; we observed marked enlargement (n = 5), perineurial thickening and disruption (n = 6), intrafascicular fibrous changes (n = 5), myelinated fibers separated by fibrous cells under the perineurium (n = 4), and Renaut bodies (n = 3). The 7th nerve appeared normal with respect to the density and size of the myelinated fibers, however, the perineurium was slightly thickened.
CONCLUSIONS: We present pathological evidence at the MCN compression site of 7 nerves from 6 patients whose LBP was alleviated by MCN neurectomy, indicating that MCN entrapment can elicit LBP.
方法:我们介绍了连续6例(7侧)难治性LBP患者,他们成功进行了MCN神经切除术。症状持续时间6~96个月,平均47.3个月;随访时间6~17个月,平均11.7个月。采用LBP数值评定量表(NRS)和Roland-Morris残疾问卷(RDQ)评分评价手术结果。切除的MCNs进行神经病理学分析。
结果:术后,所有6例患者均报告LBP立即改善;他们的NRS和RDQ评分均显著改善.对切除的7条神经的病理研究表明,6条神经的有髓纤维密度降低;我们观察到明显的扩大(n=5),神经周增厚和破裂(n=6),束内纤维变化(n=5),神经周围下由纤维细胞分离的有髓纤维(n=4),和再生机构(n=3)。第7神经的有髓纤维的密度和大小表现正常,然而,会阴膜略微增厚。
结论:我们在6例通过MCN神经切除术减轻LBP的患者的7条神经的MCN压迫部位提供了病理证据,表明MCN截留可引起LBP。