Étude de la jonction radiculo-médullaire postérieure. La radicellotomie postérieure sélective...
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,. , g, ok Review 391 F S :I~tude de la Joncrion ~adicUio-Md.dullaire Posterieure. La Radicellotomie Postdrieure S~lective dans la Ohirurgie ~gel laDouieur, Marc: $indou, Travail die t'Hopltal"" Neurologxque" et de I'Umte" " i de. Recherehes de PhySiopathol0gie duSyst~me Nerveux, Lyon, 1972. Thepossibility of performing selective posterior rh/zotomies for chronic pain was raised by Ranson'sl demonstration in the cat that the non-medullated fibres were collected together in the roots; Now, with the introduction of the operating microscope, a partial, selective cutting:of theSe afferent fibres becomes feasible. Two questions need an answer before a surgeon embarks on this operation. Firstly, are the non-myelinated fibres sufficiently grouped together on the ventrolateral side of the root for an incMon there to remGve enough of the fibres conducting impulses that finally cause pain? Secondly, can a lesion: be made there without .damaging an artery supplying the adjacent region of the spinal cord? Sindou and~Balaydier in Lyon have beenre-examining the region ~here the fibres of the posterior roots enter:the sp~t cord. This anatomical and surgical study of the junction of tl~e posterior rootlets andthe spinal cord in man is presented in this book. It is il!ustrmed by beautiful photographs, all very welt reproduced, many of which are in colour. The study shows that at a:certaLn level where the rootlet is just inside the spinal cord, its large rlyeli- noted fibres are lying medially and a great number of its very smal~ fibres are on the outer circumference of the rootlet, particularly on its ventrolateral side. Si~dou's conclusic~a is that 'the great majority of small fibres are grouped in the ventrolateral angle of the medulIo- rootlet junction, as they enter Lissauer's tract. This arrangement allows them to be sele,ztively divided at this level, without causing much damage to the large fibres.' His study also simwed the fact that a section of the ventrolateral angle of the posterior root inevitably za~lses a lesion of the vessels of the pia mater and of the pertorating vessels going into the po~;terior horn. Thus Sindou concludes that the results of an operation of this. region are due tc damage of the small spinal artery that reaches the cord beneath the ventrolateral side of ~he root. He also concludes that this lesion can destroy the non-myelinated afferent fibres of ~he roots as they lie grouped together in this region. Since publishirlg the ~ basic anatomical study in his book, Sindou and his colteagues~,3 have published the results of treating 20 patients with painful forms of cancer affe,:t~ng ~he upper limb, the pelvis and/or per~meum, and of treating 5 patients with spasticity c~using constant flexion of the lower limbs by this method. 1 Ranson, S. W., The course within the spinal cord of the non~-medullated fibre~ of the dorsal roots; a study of Lissauer's tract in the cat, J. comp. Neuro1., 23 (1913) 259-.274. 2 Sindou, M., Fischer, G., Goutelle, A., and Mansuy, L., La radicellotomie pc st~r~-~.wo s61ective, Neuro-chir., 20 (1~74) 391-.468. 3 Sindo~, ~ M., Fischer, G,, Goutelle, A., Schott, B., and Mans~y, L., La radiceltotomie post6rieure s61ective dons le traitement des spasticit~s, Rev. negroL, t30 (1974) 201--215. P.V~ . Nathan
Transcript of Étude de la jonction radiculo-médullaire postérieure. La radicellotomie postérieure sélective...
, . ,
g , ok Review
391
F S
:I~tude de la Joncrion ~adicUio-Md.dullaire Posterieure. La Radicellotomie Postdrieure S~lective dans la Ohirurgie ~gel laDouieur, Marc: $indou, Travail die t'Hopltal"" Neurologxque" et de I'Umte" "
i de. Recherehes de PhySiopathol0gie duSyst~me Nerveux, Lyon, 1972.
Thepossibility of performing selective posterior rh/zotomies for chronic pain was raised by Ranson'sl demonstration in the cat that the non-medullated fibres were collected together in the roots; Now, w i t h the introduction of the operating microscope, a partial, selective cutting:of theSe afferent fibres becomes feasible. Two questions need an answer before a surgeon embarks on this operation. Firstly, are the non-myelinated fibres sufficiently grouped together on the ventrolateral side of the root for an incMon there to remGve enough of the fibres conducting impulses that finally cause pain? Secondly, can a lesion: be made there without . damaging an artery supplying the adjacent region of the spinal cord?
S indou and~Balaydier in Lyon have beenre-examining the region ~here the fibres of the posterior roots enter:the s p ~ t cord. This anatomical and surgical study of the junction of tl~e posterior rootlets and the spinal cord in man is presented in this book. It is il!ustrmed by beautiful photographs, all very welt reproduced, many of which are in colour. The study shows that a t a:certaLn level where the rootlet is just inside the spinal cord, its large rlyeli- noted fibres are lying medially and a great number of its very smal~ fibres are on the outer circumference of the rootlet, particularly on its ventrolateral side. Si~dou's conclusic~a is that 'the great majority of small fibres are grouped in the ventrolateral angle of the medulIo- rootlet junction, as they enter Lissauer's tract. This arrangement allows them to be sele,ztively divided at this level, without causing much damage to the large fibres.' His study also simwed the fact that a section of the ventrolateral angle of the posterior root inevitably za~lses a lesion of the vessels of the pia mater and of the pertorating vessels going into the po~;terior horn. Thus Sindou concludes that the results of an operation of this. region are due tc damage of the small spinal artery that reaches the cord beneath the ventrolateral side of ~he root. He also concludes that this lesion can destroy the non-myelinated afferent fibres of ~he roots as they lie grouped together in this region.
Since publishirlg the ~ basic anatomical study in his book, Sindou and his colteagues ~,3 have published the results of treating 20 patients with painful forms of cancer affe,:t~ng ~he upper limb, the pelvis and/or per~meum, and of treating 5 patients with spasticity c~using constant flexion of the lower limbs by this method.
1 Ranson, S. W. , The course within the spinal cord of the non~-medullated fibre~ of the dorsal roots; a study of Lissauer's tract in the cat, J. comp. Neuro1., 23 (1913) 259-.274.
2 Sindou, M., Fischer, G., Goutelle, A., and Mansuy, L., La radicellotomie pc st~r~-~.wo s61ective, Neuro-chir., 20 (1~74) 391-.468.
3 Sindo~, ~ M., Fischer, G,, Goutelle, A., Schott, B., and Mans~y, L., La radiceltotomie post6rieure s61ective dons le traitement des spasticit~s, Rev. negroL, t30 (1974) 201--215.
P.V~ . Nathan
