Influence of macrophage infiltration of herniated lumbar disc tissue on outcome after lumbar disc surgery.

ABSTRACT

STUDY DESIGN: An immunohistochemical examination of the presence of inflammatory cells in routinely processed resection specimens of the lumbar disc, and a comparison of the histologic results with clinical data collected prospectively before and after surgery. OBJECTIVES: To assess the influence of inflammatory reactions in herniated lumbar disc specimens on the outcome after lumbar disc surgery. SUMMARY OF BACKGROUND DATA Histologic and biochemical studies on herniated lumbar disc tissue led to the notion of inflammation-induced sciatic pain. At this writing, no investigations have sought to discover how outcome after lumbar disc surgery is influenced by histologically described inflammation. METHODS: Disc specimens from 79 patients who underwent surgery for lumbar disc herniation were studied immunohistologically with regard to the presence of inflammatory reactions. Of these, 92% were followed up approximately 7 months after surgery. The histologic results were compared with the outcome at follow-up evaluation. RESULTS: A statistically significant correlation was found between the histologically proven inflammation and the outcome, as shown by the pain grading scale. CONCLUSIONS: The results from this study seem to support the theory of a foreign body reaction to the herniated material. This reaction may result in inflammation-induced sciatic pain.