Andrade Pablo, Hoogland Govert, Teernstra Onno P, van Aalst Jasper, van Maren Emiel, Daemen Marc A, Visser-Vandewalle Veerle
Department of Neurosurgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands; Department of Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands; Department of Neurosurgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Department of Neurosurgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, The Netherlands; Department of Neuroscience, Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands.
Spine J. 2016 Feb;16(2):243-51. doi: 10.1016/j.spinee.2015.10.038. Epub 2015 Oct 30.
Sciatica is a condition characterized by radicular pain that can be secondary to a lumbar disc herniation (LDH). More than 10% of patients report persistent pain after surgery. The underlying mechanisms of postoperative sciatica remain unclear. There is evidence demonstrating that inflammation plays a role in the pathophysiology of sciatica.
The study aimed to assess if the expression of tumor necrosis factor (TNF)-α and its receptors (TNFR) was correlated with the severity of pre- and postoperative leg pain in LDH patients who underwent single or multiple decompressive discectomies.
This is an experimental prospective human study of intraoperative intervertebral disc (IVD) samples, as well as a clinical scores evaluation.
We analyzed the mRNA and protein levels of TNF-α, TNFR1, and TNFR2 in IVD biopsies, and correlated them with visual analogue scale (VAS) scores 1 day before surgery to 6 weeks and 6 months postoperatively.
We evaluated the correlation between the inflammation in IVD with pre- and postoperative pain scores after discectomy in LDH patients operated for the first time (fLDH, N=12) and for recurrent cases (rLDH, N=8). This analysis showed that TNF-α and TNFR1 mRNA levels were significantly greater in rLDH patients; there was a twofold increase for TNF-α and a 50% increase for TNFR1. Similarly, protein levels in IVD samples positively correlated with postoperative VAS scores, whereas TNFR2 protein levels negatively correlated with postoperative VAS scores.
These findings indicate that rLDH patients present higher postoperative VAS scores compared with fLDH patients, and also that these scores are correlated with increased inflammation and may contribute to pain chronicity.
坐骨神经痛是一种以神经根性疼痛为特征的疾病，可能继发于腰椎间盘突出症（LDH）。超过10%的患者术后报告持续疼痛。术后坐骨神经痛的潜在机制尚不清楚。有证据表明炎症在坐骨神经痛的病理生理学中起作用。
本研究旨在评估肿瘤坏死因子（TNF）-α及其受体（TNFR）的表达是否与接受单次或多次减压椎间盘切除术的LDH患者术前和术后腿痛的严重程度相关。
这是一项对术中椎间盘（IVD）样本进行的实验性前瞻性人体研究，以及临床评分评估。
我们分析了IVD活检中TNF-α、TNFR1和TNFR2的mRNA和蛋白质水平，并将它们与术前1天至术后6周和6个月的视觉模拟量表（VAS）评分相关联。
我们评估了首次接受手术的LDH患者（fLDH，N = 12）和复发病例（rLDH，N = 8）椎间盘切除术后IVD炎症与术前和术后疼痛评分之间的相关性。该分析表明，rLDH患者中TNF-α和TNFR1 mRNA水平显著更高；TNF-α增加了两倍，TNFR1增加了50%。同样，IVD样本中的蛋白质水平与术后VAS评分呈正相关，而TNFR2蛋白质水平与术后VAS评分呈负相关。
这些发现表明，与fLDH患者相比，rLDH患者术后VAS评分更高，并且这些评分与炎症增加相关，可能导致疼痛慢性化。
