[Molecular mechanism of residual lumbago and leg pain after transforaminal endoscopic treatment of lumbar disc herniation].
Zhongguo Gu Shang
; 37(2): 159-65, 2024 Feb 25.
Article
en Zh
| MEDLINE
| ID: mdl-38425067
ABSTRACT
OBJECTIVE:
To observe the residual of lumbago and leg pain with contained type ï¼CTï¼ and non-contained type ï¼NCTï¼ lumbar disc herniation ï¼LDHï¼ after transforaminal endoscopic treatment, and to explore the role of hypoxia-inducible factor-1αï¼HIF-1αï¼ and transient receptor potential vanillate 1ï¼TRPV1ï¼ pathway.METHODS:
A total of 68 single-segment LDH patients were selected from July 2021 to October 2022, including 44 males and 24 femalesï¼aged 26 to 67 years old with an average ofï¼43.63±11.94ï¼ years oldï¼course of disease was 4 to 36 ï¼18.91±10.34ï¼ monthsï¼body mass index was ï¼24.45±4.00ï¼ kg·m-2ï¼there were 7 cases of L3,4 segments, 32 cases of L4,5 segments, and 29 cases of L5S1 segments. All of them were performed with percutaneous intervertebral endoscopic extraction of nucleus pulposus and were divided into contained groupï¼CT groupï¼ and non-contained group ï¼NCT groupï¼ with 34 cases respectively according to the integrity of outer layer of fibrous annulus observed during operation. A total of 17 patients who underwent open surgery for scoliosis or vertebral fracture were selected as control group, including 12 males and 5 femalesï¼aged 21 to 65 years old with an average of ï¼39.41±12.80ï¼ years oldï¼body mass index was ï¼24.86±4.11ï¼ kg·m-2. The relative mRNA expression quantity of HIF-1α, TRPV1 in nucleus pulposus were measured by quantitative real-time PCR. The contents of neurokinin 1 receptor ï¼NK1Rï¼, nerve growth factor ï¼NGFï¼, vascular endothelial growth factor ï¼VEGFï¼ in nucleus pulposus and the serum substance P ï¼SPï¼ and calcitonin gene-related peptide ï¼CGRPï¼ were detected by enzyme linked immunosorbent assay ï¼ELISAï¼. The threshold of lumbar tenderness was detected by a pressure pain meter. The degree of lumbago and lumbar function were evaluated by visual analog scale ï¼VASï¼ and Oswestry disability index ï¼ODIï¼ separately. The residual rate of postoperative lumbago and leg pain was assessed.RESULTS:
The mRNA relative expression quantity of HIF-1α and TRPV1, and the contents of NK1R, NGF and VEGF in nucleus pulposus, and the levels of serum SP and CGRP before surgery in the NCT group were higher than those in the CT groupï¼P<0.05ï¼, and those in the CT group were higher than the control groupï¼P<0.05ï¼. At day 7 after surgery, the serum SP and CGRP levels, lumbago and leg pain VAS scores and lumbar ODI index in two LDH groups were lower than before surgery ï¼P<0.05ï¼, and those in the NCT group were higher than the CT groupï¼P<0.05ï¼, and the threshold of lumbar tenderness in the NCT group was lower than the CT groupï¼P<0.05ï¼. The differences of lumbago and leg pain VAS scores, lumbar ODI index and lumbar tenderness threshold between preoperative and postoperative 7 days in the NCT group were lower than those in the CT groupï¼P<0.05ï¼. The residual rate of lumbago and leg pain at 7 days after surgery in the NCT group was higher than that in the CT groupï¼P<0.05ï¼.CONCLUSION:
HIF-1α and TRPV1 pathway promoted the excessive production of NGF, VEGF, NK1R in nucleus pulposus and serum neuropeptides SP and CGRP, which may lead to the higher residual rate of lumbago and leg pain with non-contained lumbar disc herniation postoperative.Palabras clave
Texto completo:
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Bases de datos:
MEDLINE
Asunto principal:
Dolor de la Región Lumbar
/
Discectomía Percutánea
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Desplazamiento del Disco Intervertebral
Límite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
Zh
Revista:
Zhongguo Gu Shang
Asunto de la revista:
ORTOPEDIA
/
TRAUMATOLOGIA
Año:
2024
Tipo del documento:
Article
País de afiliación:
China