Sutovsky Juraj, Sutovska Martina, Kocmalova Michaela, Kazimierova Ivana, Pappova Lenka, Benco Martin, Grendar Marian, Bredvold Harald H, Miklusica Juraj, Franova Sona
Neurosurgery Clinic, Martin University Hospital, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia.
Department of Pharmacology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia.
World Neurosurg. 2019 Jan;121:e554-e565. doi: 10.1016/j.wneu.2018.09.163. Epub 2018 Sep 29.
In lumbar degenerative spondylolisthesis (DSL), the criteria and extent of surgical treatment have not been strictly defined owing to the adjacent segment disease theory and unclear molecular pathogenesis. The present study analyzed the clinical and radiographic findings of patients after lower lumbar fusion surgery with single and 2-level DSL and explored the inflammatory mediator's role in DSL evolution and symptoms.
The prospective follow-up of patients with DSL, stratified by the stabilization extent (L4-L5, L5-S1, and L4-S1), included the Back Illness Pain and Disability 9-item questionnaire and native and dynamic radiographs to evaluate the intervertebral disc height and adjacent segments' angular motion. Follow-up examinations were performed at 3, 12, and 24 months. The pathological cytokine concentrations in the intervertebral disc and facet joints of the subchondral bone were assessed using the BioPlex assay in perioperatively collected patient samples and compared with those of control subjects obtained during multiorgan procurement. These findings were correlated with pain localization and severity.
Statistical analysis of the questionnaire data revealed significant postoperative improvement in all patients, in particular, the L4-L5 group. Also, we found radiographic evidence of angular motion reduction in both adjacent segments near the limits of statistical significance and a meaningful correlation with subjective status improvement at 24 months. BioPlex analysis revealed platelet-derived growth factor 2 B subunits, interleukin-6, interleukin-8, and tumor necrosis factor-α were elevated in spinal unit segments and the interleukin-1β levels correlated significantly with the intensity of low backache.
Our findings did not support the adjacent segment disease theory. However, later development of these changes could not be excluded. The cytokines, chemokines, and growth factors play a significant role in DSL pathogenesis and symptoms.
在腰椎退变性椎体滑脱（DSL）中，由于相邻节段疾病理论和分子发病机制尚不明确，手术治疗的标准和范围尚未得到严格界定。本研究分析了单节段和双节段DSL患者行下腰椎融合手术后的临床和影像学表现，并探讨了炎症介质在DSL演变和症状中的作用。
对DSL患者进行前瞻性随访，根据稳定范围（L4-L5、L5-S1和L4-S1）分层，包括背部疾病疼痛和残疾9项问卷以及原始和动态X线片，以评估椎间盘高度和相邻节段的角运动。在3、12和24个月时进行随访检查。使用BioPlex检测法评估围手术期收集的患者样本中椎间盘和软骨下骨小关节中的病理性细胞因子浓度，并与多器官获取过程中获得的对照受试者的浓度进行比较。这些发现与疼痛定位和严重程度相关。
对问卷数据的统计分析显示，所有患者术后均有显著改善，尤其是L4-L5组。此外，我们发现两个相邻节段的角运动减少有影像学证据，接近统计学意义的极限，并且与24个月时主观状态的改善有显著相关性。BioPlex分析显示，脊髓单元节段中血小板衍生生长因子2 B亚基（platelet-derived growth factor 2 B subunits）、白细胞介素-6、白细胞介素-8和肿瘤坏死因子-α升高，白细胞介素-1β水平与腰痛强度显著相关。
我们的研究结果不支持相邻节段疾病理论。然而，不能排除这些变化的后期发展。细胞因子、趋化因子和生长因子在DSL的发病机制和症状中起重要作用。
