University Campus Bio-Medico of Rome, CIR - Center for Integrated Research, Department of Orthopaedics and Trauma Surgery , Rome , Italy
Expert Opin Ther Targets. 2013 Dec;17(12):1461-70. doi: 10.1517/14728222.2013.834330. Epub 2013 Aug 30.
The cause of low back pain and the pathophysiology of lumbar pain and sciatica have recently been reconsidered basing on current knowledge on cellular and molecular mediators of inflammation. Several cytokines have been considered as potential therapeutic targets to contrast sciatica in patients with disc herniation, and supportive studies suggest a leading role of TNF-α in this contest: therefore, clinical trials have tested TNF-α inhibitors in the clinical setting of the patient with radicular pain secondary to an herniated disc.
The current review deals with the autoimmune theory of disc herniation and its role in determining radiculopathy and neuropathic pain. It also reports the recent evidences that led to the introduction of anti-TNF-α drugs into the clinical setting as a biological therapy for radiculopathy and disc herniation.
Targeting the TNF-α pathway has demonstrated controversial effects in the tested study population and available results only report a short-term follow-up. More confirmatory studies in terms of long-term clinical results, complications, more effective route of administration and cost-effective analysis are required to establish the real role of this biological therapy in the treatment of patients with disc herniation and neuropathy.
基于炎症的细胞和分子介质的现有知识，最近重新考虑了腰痛和坐骨神经痛的病因和病理生理学。已经有几种细胞因子被认为是治疗椎间盘突出症患者坐骨神经痛的潜在靶点，支持性研究表明 TNF-α 在这方面发挥主要作用：因此，临床试验已经在神经根性疼痛继发于椎间盘突出的患者的临床环境中测试了 TNF-α 抑制剂。
本综述涉及椎间盘突出的自身免疫理论及其在确定神经根病和神经病理性疼痛中的作用。它还报告了最近的证据，这些证据导致抗 TNF-α 药物作为神经根病和椎间盘突出症的生物治疗引入临床。
靶向 TNF-α 途径在已测试的研究人群中显示出有争议的效果，并且现有结果仅报告了短期随访。需要更多的长期临床结果、并发症、更有效的给药途径和成本效益分析的证实性研究，以确定这种生物治疗在治疗椎间盘突出症和神经病变患者中的真正作用。
