Department of General Neurosurgery, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany; School for Mental Health and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, Netherlands.
Department of Neurosurgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX, Maastricht, Netherlands.
Spine J. 2018 Dec;18(12):2316-2322. doi: 10.1016/j.spinee.2018.07.023. Epub 2018 Aug 2.
The pathophysiology of pain in patients with symptomatic thoracic disc herniation (TDH) remains poorly understood. Mere mechanical compression of the spinal cord and/or the exiting nerve root by a prolapsed disc cannot explain the pathogenesis of pain in all cases. Previous studies report a direct correlation between the levels of proinflammatory cytokines in disc biopsies and the severity of leg pain in patients with lumbar disc herniation. A similar correlation in patients with TDH has not been investigated.
To correlate the cerebrospinal fluid (CSF) expression of cytokines and pain-related amino acids with preoperative pain scores in patients with symptomatic TDH.
A prospective human study of CSF samples and clinical outcome scores.
Using enzyme-linked immunosorbent assay (ELISA) and high-performance liquid chromatography (HPLC), we determined inflammatory cytokine levels (TNF-α, IL-1β, and IL-10) and amino acid levels (glutamate, aspartate, gamma-aminobutyric acid, glycine, and arginine) in CSF samples from 10 patients with TDH and 10 control subjects who did not suffer an inflammatory disease nor pain related to spinal cord compression and subsequently correlated these levels with preoperative pain scores. Differences between both groups were evaluated by a Mann-Whitney U test. In order to estimate the correlation between cytokine or amino acid expression and pain scores, data were analyzed using a linear regression analysis.
No inflammatory cytokines were found in CSF samples from control subjects, whereas TNF-α, IL-1β, and IL-10 were detectable by ELISA in all CSF samples from patients with TDH. TNF-α and IL-10 but not IL-1β levels moderately correlated with preoperative pain scores. Elevated TNF-αlevels positively correlated with high pain scores; elevated IL-10 levels negatively correlated with high pain scores. Amino acids were detectable in all samples from both groups. There were no significant differences between the groups in any of the amino acids measured with HPLC.
Increased proinflammatory cytokine expression is associated with elevated pain scores in patients with symptomatic TDH. On the other hand, there is no conclusive correlation between the intensity of pain and the local or systemic presence of amino acids associated with pain transmission.
患有症状性胸椎间盘突出症（TDH）患者的疼痛病理生理学仍知之甚少。单纯的椎间盘突出对脊髓和/或神经根的机械性压迫并不能解释所有情况下的疼痛发病机制。先前的研究报告称，在腰椎间盘突出症患者中，椎间盘活检中的促炎细胞因子水平与腿部疼痛的严重程度之间存在直接相关性。在 TDH 患者中尚未对此相关性进行调查。
将伴有症状性 TDH 患者的脑脊液（CSF）细胞因子和与疼痛相关的氨基酸表达与术前疼痛评分相关联。
对 CSF 样本和临床结果评分的前瞻性人体研究。
使用酶联免疫吸附测定（ELISA）和高效液相色谱法（HPLC），我们测定了 CSF 样本中炎性细胞因子水平（TNF-α、IL-1β 和 IL-10）和氨基酸水平（谷氨酸、天冬氨酸、γ-氨基丁酸、甘氨酸和精氨酸）在 10 例 TDH 患者和 10 例未患有炎性疾病或与脊髓压迫相关疼痛的对照组患者的 CSF 样本中，并随后将这些水平与术前疼痛评分相关联。通过 Mann-Whitney U 检验评估两组之间的差异。为了评估细胞因子或氨基酸表达与疼痛评分之间的相关性，通过线性回归分析对数据进行了分析。
对照组患者的 CSF 样本中未发现炎性细胞因子，而 ELISA 可检测到所有 TDH 患者的 CSF 样本中均存在 TNF-α、IL-1β 和 IL-10。TNF-α和 IL-10 但不是 IL-1β 水平与术前疼痛评分中度相关。TNF-α水平升高与高疼痛评分相关；IL-10 水平升高与高疼痛评分呈负相关。两种氨基酸均在两组的所有样本中均可检测到。HPLC 测量的组间氨基酸无显着差异。
在患有症状性 TDH 的患者中，促炎细胞因子表达增加与升高的疼痛评分相关。另一方面，疼痛的强度与与疼痛传递相关的局部或全身存在的氨基酸之间没有明确的相关性。
