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Pathology of lumbar nerve root compression. Part 1: Intraradicular inflammatory changes induced by mechanical
Shigeru Kobayashi1, Hidezo Yoshizawa, Shuuichi Yamada
1Department of Orthopaedics, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Kutukake-cho, Toyoake, Aichi 470-1192, Japan [corrected] kshigeru@f8.dion.ne.jp
Study Design:
This study is to investigate the intraradicular inflammation induced by mechanical compression using in vivo model.
Objectives:
The relationship between the intraradicular edema and nerve fiber degeneration induced by mechanical compression was determined in the nerve root.
Summary Of Background Data:
Recently some studies reported that mechanical compression increased microvascular permeability of the endoneurial capillaries and resulted in an intraradicular inflammation. These changes may be an important factor of the pathogenesis of radiculopathy. However, the natural courses of the intraradicular inflammation after mechanical compression are still poorly understood.
Methods:
In dogs, laminectomy was performed at L7 and the seventh nerve root was exposed to compression at 7.5 gram force (gf) clipping power. The animals were evaluated at 1 and 3 weeks after clipping. After the appropriate period of nerve root compression, Evans blue albumin (EBA) was injected intravenously. The nerve root sections were divided into two groups. The sections were used to investigate the status of the blood-nerve barrier function under the fluorescence microscope. The other sections were used for light and transmission electron microscopic study.
Results:
After 1 and 3 weeks, intraradicular edema was observed not only at the site of compression but also in the peripheral zone of a compressed anterior root and in the central zone of a compressed posterior root. The evidence of active Wallerian degeneration was also seen in the area of intraradicular edema. In addition, the nerve roots showing Wallerian degeneration were infiltrated by inflammatory cells, such as macrophages and mast cells.
Conclusions:
Inflammatory reaction, such as Wallerian degeneration, breakdown of blood-nerve barrier and appearance of macrophage, may be deeply involved in radiculitis arising from mechanical compression, and these factors seem to be important in the manifestation of radiculopathy.