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[The morphological validation of the pathogenetic prerequisites for analgesic operations in the area of the foramina of the posterior roots].

Since 1983, a hundred and forty-five analgesic operations on the entry areas of the posterior roots were made in patients with deafferentational pain syndrome. Intraoperative findings made the authors reassess the pathogenetic mechanisms responsible for the pain syndrome and induce them to perform a thorough morphological studies of the changes occurring in the diseased posterior roots of the spinal cord and other regions of the nerve system. The morphological study was made on 20 rats that had developed chronic pain syndrome due to abruption of the brachial plexus from the spine. Experimental findings showed marked destructive changes at the site of injury, posterior, lateral, and anterior horns of the spinal cord, in the cerebellum, neurosecretory nuclei of the hypothalamus, thalamus, and cortex of the brain. These changes are regarded as transneuronal responses involving the cerebral cortex, which are accompanied by irritation and overirritation, which may be considered to be abnormal responses to a massive flux of afferent impulses emitting from the focus of the diseased spine. Changes were detected at the level of a traumatic lesion, but they were absent in other regions of the nervous system: status spongiosus in the posterior and lateral columns of the spine at the level of diseased posterior horns and glial cell proliferation in the diseased posterior horns. The proliferation contributes to the formation of hyperactive neurons that cause the pain syndrome. It may be suggested that spongious changes occurring around the spinal injury focus promote continuous glial proliferation and significantly impaired intertissue metabolism, thus maintaining abnormal activities in the focus of a lesion.