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Progress of myelination in the human fetal spinal nerve roots, spinal cord and brainstem with myelin basic protein immunohistochemistry.

The early progress of myelination was studied, by means of myelin basic protein (MBP) immunohistochemistry and luxol-fast-blue (LFB) staining, in the spinal cord, spinal nerve roots and brainstem of 66 fetuses and neonates. The degree of myelination was classified from 1 (slight) to 4 (mature). MBP immunoreactivity exhibited slight LFB positivity. Myelination first occurred in the medial longitudinal fasciculus at 20 weeks of age, reaching degree 4 at 34 weeks, but began at 23-24 weeks in the other sites. Myelination of spinal nerve roots progressed with gestation and attained degree 4 at 35-36 weeks. The cuneate fasciculus also reached degree 4 at 34-36 weeks, but corticospinal tracts and solitary tracts, which exhibited long myelinating phases, were slow and incomplete at 40 weeks. This normal development of MBP and LFB myelination can be used for the assessment of delayed myelination in fetal and neonatal diseases.

Brain Stem↗

Effects of magnitude and duration of compression on spinal nerve root conduction.

Spinal nerve root compression occurs commonly in conditions such as herniated nucleus pulposus, spinal stenosis, and trauma. However, the pathophysiology of the symptoms and signs related to spinal nerve root compression is poorly understood. The purpose of the present study was to assess and compare effects of various pressures and durations of acute compression on spinal nerve root conduction in the pig cauda equina. Efferent conduction (compound motor action potentials) and afferent conduction (compound nerve action potentials) were monitored during compression for 2 or 4 hours with compression pressures of 0 (sham), 50, 100, or 200 mm Hg. Recovery from compression was monitored for 1.5 hours. No significant deficits in spinal nerve root conduction were observed with 0 or 50 mm Hg compression, compared to significant conduction deficits induced by 100 and 200 mm Hg compression. Three-way analysis of variance demonstrated significant effects of compression pressure and duration on conduction at the end of compression and recovery, with a significant difference between efferent and afferent conduction at the end of the recovery period. These observations suggest an interaction between biomechanical and microvascular mechanisms in the production of nerve root conduction deficits. Such information may relate to the motor and sensory dysfunction in clinical conditions associated with spinal nerve root compression.

Action Potentials↗

Effects of corticosteroids on nerve root recovery after spinal nerve root compression.

Corticosteroids have been used in the treatment of radiculopathy and postoperative pain after lumbar disc surgery. Although the effects of steroids are thought to be antiinflammatory, the underlying nature of action may be more complex and may involve a direct effect on pain mediators like substance P. A feline model of nerve root compression and decompression was used to study the effect of steroids on the expression of cytokine differentiation antigens 4 and 5, and substance P. Ten adult cats were used. The animals were divided equally into a steroid treatment group and a control group. The sixth lumbar nerve root was compressed surgically and subsequently decompressed followed by local application of betamethasone or saline. The cats then were perfused and the corresponding nerve root and dorsal root ganglion were removed and immunostained for cytokine differentiation antigens 4 and 5, and substance P, respectively. The relative absence of cytokine differentiation antigens 4- and 5-labeled lymphocytes at the compression site in the steroid treated group is consistent with an antiinflammatory effect of the steroid. Substance P expression at the dorsal root ganglion in the steroid treated group was decreased significantly. These findings may help explain clinical observations of efficacy of steroids after spinal nerve root decompression.

Adrenal Cortex Hormones↗

Sheaths of the spinal nerve roots. Permeability and structural characteristics of dorsal and ventral spinal nerve roots of the rat.

The present study was carried out to investigate the permeability of normal spinal nerve root sheaths around dorsal and ventral roots in the rat. In vivo studies were performed using Evans blue-albumin and lanthanum chloride as tracers. The Evans blue-albumin complex is macromolecular in size and lanthanum ions are small and easily visible in the electron microscope. Both tracers were injected into the subarachnoid space and 15 min later samples were taken and further processed for detection of tracer. Postmortem studies with lanthanum was also performed. Following fixation by cardiac perfusion with fixative without tracer, lanthanum chloride was added to the fixative and applied directly to exposed spinal cord including the spinal nerve roots. Macroscopical examination showed Evans blue staining of the superficial blood vessels of the spinal cord, but no staining of the parenchyma of either spinal cord or nerve roots. Fluorescence microscopy revealed, in addition to a bright red fluorescence of root sheaths, a faint longitudinally orientated red fluorescence in the endoneurium of the nerve roots, indicating the presence of the dye-albumin complex. In both in vivo and post-mortem lanthanum studies, the tracer was detected between cell layers of the nerve root sheath and in invaginations of the plasma membrane of these cells, as well as inside the nerve root parenchyma. Some of the cells of the sheaths in post-mortem animals were diffusely marked with intracellular tracer. The endo-radicular lanthanum was most often seen superficially, but lanthanum could occasionally be detected deeper in the parenchyma in the post mortem studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Pressure increase in the dorsal root ganglion following mechanical compression. Closed compartment syndrome in nerve roots.

Spinal nerve roots including the dorsal root ganglion (DRG) often are mechanically deformed in connection with degenerative and traumatic conditions of the spine. However, the pathophysiology underlying various functional changes, including pain production, in such conditions is incompletely known. In this study, the tissue fluid pressure in the DRG of L5 nerve roots of rats was measured before and after compression. Normal values were found to be 3.7 +/- 0.3 cm H2O (2.7 +/- 0.2 mm Hg). After mechanical compression, the endoneurial fluid pressure in the ganglia rose to 9.6 +/- 1.7 cmk H2O (7.1 +/- 1.2 mm Hg) (P less than 0.001). Histologic examination revealed edema and haemorrhage in the endoneurial space of the DRG. Pressure increase in the DRG as a result of mechanical deformation by, for example, a herniated disc might be expected to reduce blood flow to the sensory nerve cell bodies in the DRG. This may be a mechanism underlying the production of nerve root pain, which previously has not been described.

Animals↗

Differential effects of in vitro heating on rat sciatic nerve branches and spinal nerve roots.

Locally applied heat induces nerve conduction block. Conflicting observations have been made regarding the relation of fiber conduction velocity to heat sensitivity. This study utilized sciatic nerve branches and spinal nerve roots which were heated until a substantial conduction block occurred. The results indicated that sensory fibers conducting at greater than 40 m/s are more heat-sensitive than motor fibers of the same conduction velocity.

Action Potentials↗

[Intracytoplasmic eosinophilic inclusions in dorsal root ganglia and spinal nerve roots from an autopsy case of unusual familial ataxia with cerebrospinal fluid abnormality].

Studies were performed on the light and electron microscopic structures of the dorsal root ganglia (DRG) and spinal nerve roots of the 4th lumbar nerve obtained by autopsy from a 49-year-old man with unusual familial ataxia, who showed varied neurological manifestations such as progressive ataxia, action tremors, pyramidal tract signs, mild deep sensory disturbances and autonomic dysfunctions during a 30-year period of illness, and had 2 siblings, one male and female, similarly affected and close consanguineous marriages in his family. On laboratory examinations, blood chemistry disclosed no significant findings. Repeated spinal taps showed constant xanthochromia and elevated protein in the cerebrospinal fluids. A PEG and cranial CTs revealed a progressive brain atrophy. NCVs and EMGs in the extremities were within normal limits. There was no chromosomal abnormality. Light microscopically, intracytoplasmic eosinophilic inclusions (IEIs) with pale rim, which showed varied sizes and rounded shapes, occurred within neurons in the DRG, particularly in small neurons. Many of the small neurons had numerous IEIs, and several rounded granules with a high degree of eosinophilia, measuring below 5 microns in diameter. Generally the small neurons showed atrophic, while most large neurons showed no remarkable change although they had a small number of IEIs and granules located in the perikaryal periphery. Most satellite cells, and some Schwann cells in the DRG, ventral and dorsal roots had IEIs similar to those seen in the neurons. No IEIs occurred intraaxonally, and there was seen no degenerative process in the DRG and roots except a connective tissue fiber proliferation in the DRG.(ABSTRACT TRUNCATED AT 250 WORDS)

Ataxia↗

Development of the spinal nerves of the larval lamprey: IV. Spinal nerve roots of 21-mm larval and adult lampreys, with special reference to the relation of meninges with the root sheath and the perineurium.

Spinal nerve roots of 21-mm larval and adult lampreys were electron microscopically studied. In 21-mm larval lampreys, each ventral and dorsal rootlet contains axons of various diameters enclosed together as groups in individual troughs of a Schwann cell cytoplasm, lying in direct contact with one another, and is further ensheathed entirely by a basal lamina. Dorsal roots possess visceral axons, while ventral roots lack them. In adult lampreys the ventral and dorsal roots possess individual sheaths for larger somatic axons, each being surrounded by a single Schwann cell and the basal lamina and separated from one another by a considerable amount of connective tissue. Visceral fibers are present in both the dorsal and ventral roots of adult lampreys. They aggregate to form fascicles that lie among somatic axons, being separated from them. Two layers of the meningeal tissue invaginate to form a root sheath around the distal portion of individual dorsal and ventral roots of 21-mm larval lampreys. In adult lampreys the sheath is similarly formed but extends over most of the dorsal and ventral roots. The perineurium is not developed in 21-mm larval lampreys, but is present and ensheaths only the proximal portion of spinal nerve trunks outside the meninges in adult lampreys: it is completely absent along most of the length of peripheral nerves. In both larval and adult lampreys, the outer cell layer of the root sheath is open-ended near the middle of nerve roots with respect to the extramedullary connective tissue space. Similar loosening of the cellular barrier is seen along blood vessels. Thus, the outer meningeal fibrous layer is directly continuous with the extra medullary connective tissue space by way of the inner fibrous layer of the root sheath.

Animals↗

Anomalies and malformations of lumbar spinal nerve roots.

In spinal surgery, malformations of lumbar nerve roots and their coverings may result in difficult or even faulty differential diagnoses and intraoperatively in surgical peculiarities and problems. In 5000 operations of the lumbar spine carried out within a ten-year period, 35 cases of malformation of the lumbar nerve roots were observed with 17 conjoined nerve roots emerging from the dural sac and 18 perineurial cysts in the form of cystic anomalies in the transition area of dural and arachnoid root sac into the perineurium of the spinal nerve. Due to the experience gained from these operations carried out to date, radiologic findings as to imaging as well as their interpretation, indications for surgery and intraoperative management are being discussed.

Cysts↗

The surgical anatomy of the fifth lumbar spinal nerve root.

Irritation, compression or tension of the 5th lumbar nerve root is a major cause of back pain. A sound knowledge of the anatomy of this nerve is necessary to understand the role it plays in the production of back pain. The anatomy of the 5th lumbar nerve root is reviewed, and demonstrated with dissections of 5 cadaveric spines. The possible anatomical sites of irritation, compression or tension of the 5th lumbar nerve root are listed and briefly discussed.

Humans↗

Experimental lumbar radiculopathy. Behavioral and histologic changes in a model of radicular pain after spinal nerve root irritation with chromic gut ligatures in the rat.

OBJECTIVE: The recently proposed animal model of lumbar radiculopathy was used to investigate behavioral consequences and histologic changes in spinal nerve roots, dorsal root ganglia, and spinal nerves after the L4, L5, and L6 nerve roots were loosely ligated with either silk or chromic gut sutures in an attempt to better understand the pathophysiologic mechanisms that give rise to pain associated with lumbar radiculopathy. SUMMARY OF BACKGROUND DATA: Little is known about the pathophysiologic mechanisms that give rise to pain associated with lumbar radiculopathy. The recently proposed animal model of unilateral lumbar radiculopathy, which demonstrated an association with motor paresis and thermal hyperalgesia of the affected hind limb and showed evidence of spontaneous pain has been demonstrated, may serve as a vehicle to allow direct investigation of the nature of the pathophysiological mechanisms associated with lumbar radiculopathy. METHODS: Three distinct treatments of the nerve roots were initially investigated: 1) a sham intervention, where the surgery simply exposed the nerve roots and dorsal root ganglion followed by standard closing procedures; 2) 4-0 silk ligature, where two loose ligatures of 4-0 silk were placed around the nerve roots; and 3) 4-0 chromic gut 2, where four 0.3 cm pieces of 4-0 chromic gut were laid adjacent to the nerve roots and secured by two loose ligatures of 4-0 chromic gut. STUDY DESIGN: ANOVA techniques were used to test for differential effects across time for the three treatment groups in terms of animal function. A qualitative analysis of the histology of the ipsilateral and contralateral nerve roots, dorsal root ganglia, and spinal nerves was done to correlate histologic changes with behavioral changes. RESULTS: Behavioral results were consistent with the previous study. Rats treated with chromic gut, but not silk, reliably demonstrated a prolonged thermal hyperalgesia that was maximal 2 weeks after surgery and lasted for up to 12 weeks. These behavioral changes, however, were not correlated with histologic changes in myelinated fiber content in the L4, L5, and L6 nerve roots, dorsal root ganglia and spinal nerves, the ipsilateral spinal nerved, dorsal root ganglia, and nerve roots of rates ligated with silk or chromic gut showed similar, significant, decreased in the number of large diameter myelinated fibers. CONCLUSIONS: These results suggest that mechanical constriction of the L4, L5, and L6 spinal nerve roots, as evidenced by a loss of myelinated fibers, is not sufficient to produce the behavioral effects associated with this model of lumbar radiculopathy. It is hypothesized that chemical factors from the chromic gut play a role in the pathophysiology and development of the behavioral, but not histological, changes in this model of lumbar radiculopathy.

Animals↗