Pathogenesis analysis of sciatica on lumbar disc herniation. Changes of nerve root evoked potentials and oxygen concentration induced by intraoperative SLR test

• Project/Area Number: 25460719
• Research Category: Grant-in-Aid for Scientific Research (C)
• Allocation Type: Multi-year Fund
• Section: 一般
• Research Field: Pain science
• Research Institution: University of Fukui
• Principal Investigator: 小林 茂 福井大学, 学術研究院医学系部門(附属病院部), 准教授 (80234821)
• Project Period (FY): 2013-04-01 – 2017-03-31
• Project Status: Discontinued (Fiscal Year 2016)
• Budget Amount: ¥5,200,000 (Direct Cost: ¥4,000,000、Indirect Cost: ¥1,200,000); Fiscal Year 2017: ¥650,000 (Direct Cost: ¥500,000、Indirect Cost: ¥150,000); Fiscal Year 2016: ¥390,000 (Direct Cost: ¥300,000、Indirect Cost: ¥90,000); Fiscal Year 2015: ¥390,000 (Direct Cost: ¥300,000、Indirect Cost: ¥90,000); Fiscal Year 2014: ¥520,000 (Direct Cost: ¥400,000、Indirect Cost: ¥120,000); Fiscal Year 2013: ¥3,250,000 (Direct Cost: ¥2,500,000、Indirect Cost: ¥750,000)
• Keywords: 神経根 / 坐骨神経痛 / 腰椎椎間板ヘルニア / 酸素濃度 / ＳＬＲテスト / 椎間板ヘルニア / 根電位 / 根内血流 / 脊柱管狭窄 / straight leg raisingテスト / 脊柱管狭窄症

Outline of Annual Research Achievements

これまで腰椎椎間板ヘルニアでみられる根性疼痛（坐骨神経痛など）の発現機序の解明に下肢の運動によって可動する神経根そのものの機能変化に着目した研究は少なく、手術中にヘルニア摘出後の神経根機能の改善を確認することは、術後の遺残性疼痛を予防し、今後の更なる治療成績を向上させるうえで重要である。
本研究では、手術中にstraightleg raising(SLR)テストを施行し、ヘルニア摘出前後の神経根の動態と根内の酸素濃度の変化を観察し、手術中に神経根の機能回復が得られたかどうかを容易に確認できる検査法を確立した。術中ヘルニア摘出時に神経根を加護的に取り扱い、術後麻痺等の遺残症状を回避するために術中の神経根内の酸素濃度の計測は有用であり、椎間板ヘルニア手術の医療安全に大きく貢献すると考えられた。
今後、更に症例数を増やし、神経根と椎間板ヘルニアの癒着状況、坐骨神経痛との関連を電気生理学的手法と病理組織学的手法を用いて精査していく予定であったが、研究代表者は平成２８年１２月２２日より研究継続が不可能となったため、研究を中断することとなった。

Research Products

• [Journal Article] Circulatory dynamics of the cauda equina in lumbar canal stenosis using dynamic contrast-enhanced MR imaging (2015)
  • Author(s): Kobayashi S, Suzuki Y, Meir A, Al-Khudairi N, Nakane T, Hayakawa K
  • Journal Title: Spine J Volume: 15 Issue: 10 Pages: 2132-2141
  • DOI: 10.1016/j.spinee.2015.05.014
  • Peer Reviewed / Open Access / Int'l Joint Research / Acknowledgement Compliant
• [Journal Article] Pathophysiology, diagnosis, and treatment of intermittent claudication in patients with lumbar canal stenosis. (2014)
  • Author(s): Kobayashi S
  • Journal Title: World J Orthop Volume: 5 Issue: 2 Pages: 134-145
  • DOI: 10.5312/wjo.v5.i2.134
  • Peer Reviewed / Open Access / Acknowledgement Compliant
• [Journal Article] Changes of blood flow, oxygen tension, action potential and vascular permeability induced by arterial ischemia or venous congestion on the spinal cord in canine model (2013)
  • Author(s): 1. Kobayashi S, Yoshizawa H, Shimada S, Guerrero AR, Miyachi M.
  • Journal Title: J Orthop Res Volume: 31 Issue: 7 Pages: 139-146
  • DOI: 10.1089/neu.2008.0837
• [Presentation] Mechanism of developing sciatica experienced in lumbar disc herniation: Change in intraradicular oxygen saturation by intraoperative SLR test (2016)
  • Author(s): Kobayashi S, Yonezawa T, Hashishin Y, Matsuoka H
  • Organizer: 43th The International Society for the Study of the Lumbar Spine (ISSLS)
  • Place of Presentation: Singapore
  • Year and Date: 2016-05-16
  • Int'l Joint Research
• [Presentation] Low back and root pain pathology (2016)
  • Author(s): Kobayashi S
  • Organizer: 3rd Nepal Japan Combined Orthopaedic symposium
  • Place of Presentation: Pokhara，Nepal
  • Year and Date: 2016-02-11
  • Int'l Joint Research / Invited
• [Presentation] Pathogenesis analysis of sciatica on lumbar disc herniation. Changes of nerve root evoked pot entails and oxygen concentration induced by intraoperative SLR test (2016)
  • Author(s): Kobayashi S, Yonezawa T, Hashishin Y, Matsuoka H
  • Organizer: 3rd Nepal Japan Combined Orthopaedic symposium
  • Place of Presentation: Pokhara，Nepal
  • Year and Date: 2016-02-11
  • Int'l Joint Research
• [Presentation] Changes of intraradicular oxygen saturation during straight-leg-raising (SLR) test on lumbar disc herniation (2015)
  • Author(s): Kobayashi S, Yonezawa T, Hashishin Y, Matsuoka H
  • Organizer: ORS PSRS 3rd International Spine Research Symposium
  • Place of Presentation: Phyladelphia, US
  • Year and Date: 2015-11-09
  • Int'l Joint Research
• [Presentation] Chondrotoxic Effects of Local Analgesics: Effect of lidocaine on chondrocytes under low osmotic conditions (2015)
  • Author(s): Kobayashi S, Miyazaki T,Takeno K.
  • Organizer: 61th-Annual Meeting of the Orthopaedic Research Society
  • Place of Presentation: Lasvegas, US
  • Year and Date: 2015-03-28 – 2015-04-01
• [Presentation] Changes of Residual Disc Bulging After Successful Lumbar Microdiscectomy on Postoperative MR Imaging (2015)
  • Author(s): Kobayashi S, Miyazaki T, Kosaka R, Hayakawa K.
  • Organizer: 61th-Annual Meeting of the Orthopaedic Research Society
  • Place of Presentation: Lasvegas, US
  • Year and Date: 2015-03-28 – 2015-04-01
• [Presentation] Electrophysiological Changes of Median Nerve Induced by An Intraoperative Phalen’s Test on Carpal Tunnel Syndrome (2015)
  • Author(s): Kobayashi S, Yayama T, Awara K, Adam M, Hayakawa K.
  • Organizer: 61th-Annual Meeting of the Orthopaedic Research Society
  • Place of Presentation: Lasvegas, US
  • Year and Date: 2015-03-28 – 2015-04-01
• [Presentation] 椎間板変性でみられる低浸透圧下でアレンドロネートが髄核細胞のプロテオグリカン代謝に及ぼす影響 (2014)
  • Author(s): 小林 茂、宮崎 剛、竹野建一
  • Organizer: 第29回日本整形外科学会基礎学術集会
  • Place of Presentation: 鹿児島（城山観光ホテル）
  • Year and Date: 2014-10-09 – 2014-10-10
• [Presentation] 成長因子を用いた椎間板再生医療の臨床応用への関門：Bone morphogenetic proten-7 や線維芽細胞増殖因子がグリコサミノグリカン産生に及ぼす影響 (2014)
  • Author(s): 小林 茂、竹野建一、宮崎 剛、J. P. G. Urban
  • Organizer: 第29回日本整形外科学会基礎学術集会
  • Place of Presentation: 鹿児島（城山観光ホテル）
  • Year and Date: 2014-10-09 – 2014-10-10
• [Presentation] Spontaneous regression mechanisms of lumbar disc herniation: Role of apoptosis and macrophages during disc tissue resorption. (2014)
  • Author(s): Kobayashi S, Kosaka R, Meir A.
  • Organizer: Eurospine 2014
  • Place of Presentation: Lyon, France
  • Year and Date: 2014-10-01 – 2014-10-03
• [Presentation] Effect of alendronate on proteoglycan production and cell metabolism in bovine disc cells in alginate culture. (2014)
  • Author(s): Kobayashi S, Miyazaki T, Meir A, Kosaka R.
  • Organizer: Eurospine 2014
  • Place of Presentation: Lyon, France
  • Year and Date: 2014-10-01 – 2014-10-03
• [Presentation] Pathogenesis of cervical myelopathy in chronic cervical cord compression model of rat. (2014)
  • Author(s): Kobayashi S, Kubota M, Iwamoto H, Kosaka R, Hayakawa K.
  • Organizer: Eurospine 2014
  • Place of Presentation: Lyon, France
  • Year and Date: 2014-10-01 – 2014-10-03
• [Presentation] Morphological changes of the cervical spinal canal and cord due to aging on MR imaging. (2014)
  • Author(s): Kobayashi S, Hayakawa K, Nakane T, Kosaka R.
  • Organizer: Eurospine 2014
  • Place of Presentation: Lyon, France
  • Year and Date: 2014-10-01 – 2014-10-03
• [Presentation] Physical limitations to tissue engineering of intervertebral disc: Limited effect of transforming growth factor (TGF)-β, fibroblast growth factor (FGF)-2 and osteogenic protein (OP)-1. (2014)
  • Author(s): Kobayashi S, Takeno K, Miyazaki T, Kosaka R, Meir A.
  • Organizer: Eurospine 2014
  • Place of Presentation: Lyon, France
  • Year and Date: 2014-10-01 – 2014-10-03
• [Presentation] Aseptic bone necrosis induced by percutaneous laser disc decompression (PLDD): MR imaging and clinical correlation. (2014)
  • Author(s): Kosaka R, Kobayashi S, Yonezawa T.
  • Organizer: Eurospine 2014
  • Place of Presentation: Lyon, France
  • Year and Date: 2014-10-01 – 2014-10-03
• [Presentation] Sciatica: Pathogenesis and it’s treatment (Micro-PLIF). (2014)
  • Author(s): Kobayashi S.
  • Organizer: Queen Square Anglo-Japanease Research Meeting and Elective Medical Student Teaching.
  • Place of Presentation: London, UK
  • Year and Date: 2014-09-29
  • Invited
• [Presentation] Pathomechanisms of sciatica induced by disc herniation: Ultrastructural changes of vascular component in the periradicular adhesive tissue. (2014)
  • Author(s): Kobayashi S, Takeno K.
  • Organizer: 41th-International Society for the Study of the Lumbar Spine
  • Place of Presentation: Seoul, Korea
  • Year and Date: 2014-06-03 – 2014-06-07
• [Presentation] Alendronate chondroprotective effects on disc cells and articular chondrocytes in vitro: Dose-response studies. (2014)
  • Author(s): Kobayashi S, Miyazaki T.
  • Organizer: 41th-International Society for the Study of the Lumbar Spine
  • Place of Presentation: Seoul, Korea
  • Year and Date: 2014-06-03 – 2014-06-07
• [Presentation] Pathomechanisms of Sciatica in Lumbar Disc Herniation. Ultrastructural Analysis of Periradicular Adhesive Tissue (2014)
  • Author(s): Kobayashi S, Takeno K
  • Organizer: The 60th Annual Meeting of the Orthopaedic Research Society
  • Place of Presentation: NewOreans, US
• [Presentation] Alendronate Chondroprotective Effects in vitro. Effect of Alendronate on Glycosaminoglycan Production and Cell Metabolism under Low Osmotic As Seen in Disc Degeneration (2014)
  • Author(s): Kobayashi S, Miyazaki T, Takeno K
  • Organizer: The 60th Annual Meeting of the Orthopaedic Research Society
  • Place of Presentation: NewOreans, US
• [Presentation] Pathomechanisms of Sciatica Induced by Disc Herniation. Ultrastructural Changes of Vascular Component in the Periradicular Adhesive Tissue (2014)
  • Author(s): Kobayashi S, Takeno K
  • Organizer: The 41th International Society for the Study of the Lumbar Spine (ISSLS)
  • Place of Presentation: Seoul, Korea
• [Presentation] Alendoronate chondroprotective effects on disc cells and articular chondrocytes in vitro: Dose-response studies (2014)
  • Author(s): Kobayashi S, Miyazaki T
  • Organizer: The 41th International Society for the Study of the Lumbar Spine (ISSLS)
  • Place of Presentation: Seoul, Korea
• [Presentation] Physical Limitations to Tissue Engineering of Intervertebral Disc Cells Using Growth Factors. Effect of Bone Morphogenetic Proten (BMP)-7 and Fibroblast Growth Factor (FGF)-2 on Glycosaminoglycan Production and Cell Metabolism (2014)
  • Author(s): Kobayashi S, Takeno K
  • Organizer: The 41th International Society for the Study of the Lumbar Spine (ISSLS)
  • Place of Presentation: Seoul, Korea
• [Book] Local anesthetics: current concepts and emerging roles in clinical practice: Chondrotoxic Effects of Local Analgesics: Changes in Cell Viability and Proteoglycan Metabolism After Intraarticular injection of Lidocaine (2014)
  • Author(s): Kobayashi S
  • Total Pages: 32
  • Publisher: Nova
• [Book] Current Concepts and Emerging Roles in Clinical Practice (2014)
  • Author(s): Kobayashi S
  • Total Pages: 88
  • Publisher: Nova Science Publishers