Beyaz Serbülent Gökhan, İnanmaz Mustafa Erkan, Ergönenç Tolga, Palabıyık Onur, Tomak Yakup, Tuna Ayça Taş
Department of Anesthesiology and Pain Medicine, Sakarya University Faculty of Medicine, Sakarya, Turkey.
Department of Orthopedics and Traumatology, Sakarya University Faculty of Medicine, Sakarya, Turkey.
Anesth Essays Res. 2017 Oct-Dec;11(4):898-901. doi: 10.4103/aer.AER_160_17.
Inflammatory cytokines secreted from the nucleus pulposus are thought to lead to lumbar nerve root compression-like symptoms. Tumor necrosis factor-alpha (TNF-α), an inflammatory cytokine, likely plays an important role in lumbar disc hernia-related leg pain. In this experimental study, we compared the effectiveness of TNF-α antagonists administered through the intravenous or epidural route in lumbar spine pathologies.
After ethics committee approval had been obtained, 24 Sprague Dawley male rats aged 70-90 days and weighing 250-300 g each were allocated to four groups. In Group I, only the surgical procedure was performed; in Group II, 1 ml of saline solution was administered into the epidural field; in Group III, 10 mg/kg of infliximab was administered into the coccygeal vein; and in Group IV (epidural group), 25 mg of etanercept was administered into the epidural region.
When the left leg pull values were analyzed on day 14, whereas there was not a significant difference among the three groups, a decreasing difference was observed in Group IV ( < 0.05). When the 21 and 28 day left leg pull values were compared between groups, the values from Groups II, III, and IV were significantly lower than those of Group I ( < 0.05).
The absence of a difference between the baseline values and left leg pull values on days 14, 21, and 28 in Group IV indicates that recovery began on day 21 with the epidural administration of etanercept. There was no difference between intravenous saline administration and intravenous infliximab administration with regard to the start of the recovery. In the present study of rats with discopathy, TNF-α antagonists administered epidurally led to earlier recovery from radiculopathy-related allodynia compared to intravenous administration.
髓核分泌的炎性细胞因子被认为会导致腰神经根受压样症状。肿瘤坏死因子-α（TNF-α）作为一种炎性细胞因子，可能在腰椎间盘突出症相关腿痛中起重要作用。在本实验研究中，我们比较了经静脉或硬膜外途径给予TNF-α拮抗剂对腰椎疾病的疗效。
在获得伦理委员会批准后，将24只70 - 90日龄、体重250 - 300克的雄性Sprague Dawley大鼠分为四组。第一组仅进行手术操作；第二组在硬膜外腔注入1毫升生理盐水；第三组经尾静脉注入10毫克/千克英夫利昔单抗；第四组（硬膜外组）在硬膜外区域注入25毫克依那西普。
在第14天分析左腿拉力值时，三组之间无显著差异，但第四组观察到有下降差异（<0.05）。比较各组在第21天和28天的左腿拉力值时，第二组、第三组和第四组的值显著低于第一组（<0.05）。
第四组在第14天、21天和28天的基线值与左腿拉力值之间无差异，表明在硬膜外给予依那西普后，恢复在第21天开始。静脉注射生理盐水与静脉注射英夫利昔单抗在恢复开始方面无差异。在本椎间盘病大鼠研究中，与静脉注射相比，硬膜外给予TNF-α拮抗剂可使神经根病相关的异常性疼痛恢复得更早。
