B. Rydevik

Edema formation in spinal nerve roots induced by experimental, graded compression. An experimental study on the pig cauda equina with special reference to differences in effects between rapid and slow onset of compression.

Edema formation in spinal nerve roots of the pig cauda equina was studied following experimental compression at various pressure levels, durations, and rates of onset, using a fluorescence microscopic technique. The time–pressure thresholds for the occurrence of edema in the nerve roots were: following rapid onset of compression (0.05–0.1 seconds), 2 minutes at both 50 mm Hg and 200 mm Hg, and following slow onset of compression (the pressure was slowly increased during 15–20 seconds), 2 hours at 50 mm Hg and 2 minutes at 200 mm Hg. Generally, the edema formation was more pronounced after rapid than after slow onset of compression. The data in this study also indicate that intraneural edema might be more easily formed in nerve roots than in peripheral nerves after compression injury.

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 cm H2O (7.1 ± 1.2 mm Hg) (P < 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.

EFFECTS OF ACUTE, GRADED COMPRESSION ON SPINAL NERVE ROOT FUNCTION AND STRUCTURE : AN EXPERIMENTAL STUDY OF THE PIG CAUDA EQUINA

A well-controlled experimental model for analysis of compression-induced functional changes of the porcine cauda equina is presented. The model allows for electrophysiologic investigation of a variety of neurophysiologic changes induced by nerve root deformation. At an acute pressure threshold of 50-75 mm Hg, changes in both afferent and efferent conduction are induced. With higher compression pressure, a differential recovery in afferent and efferent conduction is seen.

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.

1990 AcroMed Award in basic science. Cauda equina anatomy. II: Extrathecal nerve roots and dorsal root ganglia.

Inconsistent data exist regarding the anatomy of the spinal nerve roots lateral to the thecal sac. A newly developed in situ technique was used to precisely define anatomic parameters on 20 fresh human cadavers. The take-off angle of the nerve roots from the thecal sac decreases from a mean of approximately 40° from L1-L5 to 22° at S1. The motor bundles are directly ventral to the sensory fibers within individual roots extrathecally. Dorsal root ganglia size varies with vertebral level. The majority of ganglia lie dirctly beneath the vertebral pedicles, and one third overlie a portion of the lateral intervertebral disc. These previously undescribed relationships may aid in the understanding of lumbosacral neurocom-pressive disorders and are important to note during pedicle screw insertion, posterolateral decompression for spinal trauma, and paravertebral approaches for lateral disc herniations.

Experimental nerve root compression : a model of acute, graded compression of the porcine cauda equina and an analysis of neural and vascular anatomy

Nerve root compression has been suggested as one important pathogenetic factor in low-back pain syndromes and sciatica. The underlying pathophysiologic mechanisms are, however, incompletely known, partly because of the lack of experimental data on this topic. In the present study, a model for experimental compression of the porcine sacrococcygeal cauda equina is presented. The model consists of surgical exposure of the cauda equina and compression of the cauda equina toward the ventral aspect of the spinal canal by an inflatable balloon fixed to the spine. This compression system was shown to have a high accuracy in pressure transmission from the balloon to the cauda equina. The gross and microscopic neural anatomy and the vascujar anatomy of the porcine cauda equina were analyzed with light microscopic and ink-perfusion techniques. The porcine cauda equina showed a close anatomic resemblance to the human lumbosacral cauda equina. The presented model offers unique possibilities for experimental studies on nerve root compression injury because of the easy surgical exposure and the sufficient length of the nerve roots. In separate studies, this model, along with investigations of solute transport to the nerve tissue and of impulse propagation, has been used to analyze the effects of acute, graded compression on blood flow and edema formation in the cauda equina. The porcine cauda equina would also be particularly suitable for chronic compression studies because any neurologic deficit acquired would be restricted to the tail.

Compression-induced changes of the nutritional supply to the porcine cauda equina.

The effects of compression on the transport of 3H-labeled methyl glucose to spinal nerve roots were analyzed in an experimental model of the pig cauda equina. A rapid onset of compression (0.05-0.1 s) induced more pronounced effects than a slow onset (20 s) at corresponding pressure levels. There was evidence that this observed difference may be related to the magnitude of intraneural edema formed outside the compression zone. The results also indicate that the nutritional transport might be impaired at very low pressure levels and that diffusion from adjacent tissues with a better nutritional supply, including the cerebrospinal fluid, may not fully compensate for any compression-induced impairment of the intraneural blood flow.

Importance of Compression Onset Rate for the Degree of Impairment of Impulse Propagation in Experimental Compression Injury of the Porcine Cauda Equina

The effects of a rapid (0.05–0.1 seconds) and a slow (20 seconds) onset rate of cauda equina compression on impulse propagation, in terms of tail muscle electromyogram (EMG) amplitude, were analyzed in an experimental model of the pig cauda equina. Sham compression and compression at 50 mm Hg at either rapid or slow onset induced no or only minor functional impairment. Compression at 100 or 200 mm Hg induced impairment of the impulse propagation that was proportional to the applied pressure. The effects were more pronounced (P < 0.01) for the rapid than for the slow onset of compression at both these pressure levels. An important factor for this observed difference in effects between the two employed onset rates seems to be the magnitude of intraneural edema formed outside the compression zone.

Neuropeptide Changes in Compressed Spinal Nerve Roots

Study Design Compression-induced changes in the concentration of substance P and VIP (vasoactive intestinal polypeptide), in spinal nerve roots and dorsal root ganglia were studied in an experimental nerve root compression model in pigs. Objectives To analyze by radioimmunoassay the concentration of the neuropeptides substance P and VIP in a model for experimental chronic nerve root compression. Summary of Background Data Neuropeptides such as substance P and VIP seem to be involved in the transmission of pain and changes in the levels of these neuropeptides have been described in models where peripheral or spinal nerve injury was induced. Methods An ameroid constrictor was applied on a spinal nerve root just cranial to the dorsal root ganglion. The inner diameter of this constrictor is gradually reduced. After 1 or 4 weeks, tissue samples were taken from the nerve root cranial to the constrictor and from the dorsal root ganglion for measurement of substance P and VIP concentrations. Results There was statistically significant increase in substance P concentrations in the compressed dorsal root ganglia when compared to the noncompressed dorsal root ganglia at both 1 and 4 weeks. Substance P concentration was also significantly increased in the nerve root after 1 but not after 4 weeks. The VIP levels were not significantly changed in either tissue. Conclusions The results of the study indicates an increase in substance P levels in the dorsal root ganglion (after 1 and 4 weeks) and in the nerve root (after 1 week) in a model for chronic nerve root compression in pigs. There were no significant differences in the VIP concentrations. The study thus indicates that changes in substance P are related to experimental chronic nerve root compression.

Cauda Equina Anatomy I: Intrathecal Nerve Root Organization

The three-dimensional organization of the human cauda equina has not been described previously. This is partly due to the difficulties of dissecting individual, unfixed nerve roots. By the use of a newly developed in situ fixation and embedding technique on 15 fresh human cadavers, the cross-sectional anatomy of the cauda equina was defined from L2-L3 to L5-S1. A highly consistent cross-sectional pattern was observed in all specimens. The lower sacral (S2-S5) and coccygeal roots were located in the dorsal aspect of the thecal sac, whereas the lumbar and first sacral roots exhibited an oblique, layered pattern as they ascended. The motor bundle was situated anteromedial to its respective sensory bundle within each layer, Invaginations of arachnoid held the nerve roots in a fixed relationship to one another. This previously undescribed three-dimensional anatomy within the thecal sac may aid in the understanding and treatment of trauma, neurocompressive syndromes, and tumors of the cauda equina.