METHODS: This study enrolled 19 consecutive patients under the same protocol. Microsurgical observation through exposure of C4 to Th1 medullary segments allowed to describe the lesions in spinal nerve roots, meninges, and spinal cord. Electrical stimulation of the ventral roots checked the muscle responses.
RESULTS: Extensive damage was observed among the 114 explored roots (six roots per patient), with only 21 (18.4%) ventral (VR) and 17 (14.9%) dorsal (DR) roots retaining all rootlets intact. Damage distribution varied, with the most frequent impairments in C6 VRs (18 patients) and the least in Th1 VRs (14 patients), while in all the 19 patients for the C6 DRs (the most frequently impaired) and in 14 patients for Th1 DRs (the less impaired). C4 roots were found damaged in 12 patients. Total or partial avulsions affected 63.3% and 69.8% of DRs and VRs, respectively, while 15.8% and 14.0% of the 114 DRs and VRs were atrophic, maintaining muscle responses to stimulation in half of those VRs. Pseudomeningoceles were present in 11 patients but absent in 46% of avulsed roots. Adhesive arachnoiditis was noted in 12 patients, and dorsal horn parenchymal alterations in 10.
CONCLUSIONS: Knowledge of intradural lesions post-BPI helps in guiding surgical indications for repair and functional neurosurgery for pain control.
方法:本研究在相同方案下连续招募19名患者。通过将C4暴露于Th1髓段进行显微外科观察,以描述脊神经根的病变,脑膜,和脊髓。电刺激腹根检查肌肉反应。
结果:在114个探索的根中观察到广泛的损伤(每个患者有6个根),只有21根(18.4%)腹侧(VR)和17根(14.9%)背根(DR)保持所有小根完整。损伤分布变化,C6VRs损伤最常见(18例),Th1VRs损伤最少(14例),而在所有19例患者中,C6DR(最常受损)和14例Th1DR(受损较少)。在12例患者中发现C4根受损。全部或部分撕脱影响了63.3%和69.8%的DR和VR,分别,而114个DR和VR中的15.8%和14.0%是萎缩的,在一半的VR中保持肌肉对刺激的反应。11例患者存在假性脑膜膨出,但46%的撕脱根中不存在。12例患者出现粘连性蛛网膜炎,和10例的背角实质改变。
结论:了解BPI术后硬膜内病变有助于指导修复手术指征和功能性神经外科控制疼痛。