Effects of lidocaine on nucleus pulposus-induced nerve root injury. A neurophysiologic and histologic study of the pig cauda equina.
METHODS
Application of autologous nucleus pulposus on nerve roots and treatment with local application of lidocaine in the pig.


OBJECTIVE
Studies of the effects of lidocaine on nucleus pulposus-exposed nerve roots.


BACKGROUND
Nerve root infiltration may improve radicular symptoms beyond the pharmacologic duration of local anesthetics, but the mechanisms for this effect are not known.


METHODS
Nucleus pulposus was harvested from a lumbar disc and placed onto the sacrococcygeal cauda equina in pigs. In Series 1, early lidocaine treatment of nucleus pulposus-induced nerve root injury, pigs received 2% lidocaine (n = 5) or saline (n = 5) before and after surgery. Nerve conduction velocity and histologic appearance were studied after 3 days. In Series 2, delayed lidocaine treatment of nucleus pulposus-induced nerve root injury, after 7 days 2% lidocaine was administered epidurally to nucleus pulposus-exposed (n = 4) and -nonexposed (n = 4) nerve roots. Nerve conduction velocity, muscle action potentials, and histologic appearance were assessed.


RESULTS
In Series 1, early treatment with lidocaine limited the reduction in nerve conduction velocity. The epidural inflammation was less in lidocaine treated animals. In Series 2, nerve conduction velocity was lower in nucleus pulposus-exposed animals than in nonexposed animals. The initial reduction of nerve conduction velocity and muscle action potential was similar between the groups, but the recovery of muscle action potential was slower and less complete in nucleus pulposus-exposed nerve roots. There was minimal histologic nerve injury in both series and in both protocols.


CONCLUSIONS
Early treatment with lidocaine may reduce nucleus pulposus-induced nerve root injury. Lidocaine induced a delayed recovery in nerve roots exposed to nucleus pulposus. Further studies are needed to clarify the therapeutic effects of nerve root infiltration and the pathophysiology of nucleus pulposus-induced nerve root injury.
Yabuki
S
S
Department of Orthopaedics, Sahlgren University Hospital, Sweden.
Kawaguchi
Y
Y
Nordborg
C
C
Kikuchi
S
S
Rydevik
B
B
Olmarker
K
K
D000779:Anesthetics, Local / Q000494:pharmacology*; D000818:Animals; D002420:Cauda Equina / Q000187:drug effects / Q000473:pathology* / Q000503:physiopathology; D007403:Intervertebral Disc / Q000637:transplantation*; D008012:Lidocaine / Q000494:pharmacology*; D008159:Lumbar Vertebrae; D009431:Neural Conduction / Q000187:drug effects; D013552:Swine; D014182:Transplantation, Autologous
D000779:Anesthetics, Local; D008012:Lidocaine