椎板切除術 (laminectomy) 是目前最常用來緩解神經根壓迫、坐骨神經痛、下肢疼痛以及下背痛的手術。然而在手術後長期追蹤下，發現竟然有高達40%的病人不滿意手術結果，顯然就長期而言，脊椎手術之結果仍然未臻理想。而無論何種原因引起背痛，經手術後症狀沒有改善，卻依然有持續背痛等症狀，在臨床上統稱為脊椎術後症候群 (failed back surgery syndrome; FBSS)。造成脊椎術後症候群的原因有很多，且牽涉的層面相當廣泛，但是在眾多原因之中，術後瘢痕組織 (epidural fibrosis) 的形成可說是一個明顯且重要的因素；據臨床報告指出，約有24-60%脊椎術後症候群的患者是由瘢痕組織所引起。有學者認為，瘢痕組織之所以會造成術後的併發症狀，是因為瘢痕組織對脊柱內神經組織產生沾粘、壓迫和撕扯的作用；反觀使用MRI深入研究後，卻有學者提出不同的意見；直至目前為止，雖然大多數的學者主張脊椎術後瘢痕組織確實會引起脊椎術後疼痛與坐骨神經痛，但是，究竟它是如何引起術後疼痛其確實的機轉仍然未有定論。在此之前，針對纖維組織的大小及延伸已有許多組織學上的探討，但是針對鄰近纖維化的神經纖維，如馬尾束神經根、背根神經節或纖維組織，其細胞構造卻鮮少深入研究。而於我們實驗室前一階段研究發現，瘢痕組織所沾粘的馬尾區域之神經根在光學顯微鏡觀察下似乎有病理上的變化，因此，本實驗的第一個目的，就是要更進一步使用電子顯微鏡去探討這些神經根之超微結構。除此之外，我們根據多數學者的研究結果，提出實驗假說，認為脊椎術後瘢痕組織的生長與脊椎術後症候群應有相當程度的關聯；術後瘢痕組織內可能有神經異常增生，並且這些增生的神經是與疼痛有關之神經纖維。我們使用一般研究脊椎術後瘢痕組織的動物實驗模式，利用免疫染色、光學顯微鏡及電子顯微鏡，進一步探討脊椎術後瘢痕組織與脊椎術後症候群在病態生理學上的關連性。根據實驗結果發現，脊椎術後瘢痕組織所沾粘區域之神經纖維發生髓鞘與軸突的病變，而此病變絕大部分都發生在大型神經纖維，並且也觀察到發炎細胞出現在神經根當中。而針對瘢痕組織進一步觀察發現，確實有神經異常增生至術後瘢痕組織當中，而這些增生的神經，包括痛覺神經纖維以及交感神經纖維。總結實驗結果，我們推論，因術後瘢痕組織所引發的脊椎術後症候群之症狀，不僅是由瘢痕組織壓迫神經根所造成，術後神經根的病變以及瘢痕組織中異常增生的神經，都可能是造成脊椎術後症候群的原因之一。

Background data: Failed back surgery syndrome (FBSS) is a frustrated complication for the patients and spinal surgeons. Among the various etiologies, postlaminectomy peridural fibrosis is thought to be an important cause of FBSS. The relevance between the fibrotic scar and the postoperative pain following lumbar laminectomy is, however, still unclear. Objective: To assess if the postlaminectomy induced epidural fibrosis would be the cause of FBSS. Study design: The morphological changes of the neural tissues, including the epidural fibrotic scar, cauda equina, and the dorsal root ganglion, after laminectomy were assayed. Method: The neural tissues were harvested from rats at postlaminectomy (L5) 1- and 3- month later and analyzed by electron microscopy and immunohistochemistry. Results: Degenerative changes with dysmyelination and progressive axonopathy which occurred in the intradural nerve roots adjacent to the postlaminectomy epidural fibrosis. Besides, many inflammatory cells infiltration were observed. In the epidural fibrotic tissue, the appearance of new in-growth fibers, which showed immunoactive to protein gene product 9.5 (PGP 9.5), substance P (SP), tyrosine hydroxylase (TH), and calcitonin gene-related peptide (CGRP), were suggestive to possess both pain and sympathetic nerve components. In the dorsal root ganglion, there were increasing lipofuscin granules accumulated in the cytoplasm of sensory neuronal soma. Conclusions: These findings indicate the epidural fibrosis play a certain role in the FBSS.

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