The Inflammatory Effect of Nucleus Pulposus

McCARRON, Robert F.; Wimpee, Marc W.; Hudkins, Philip G.; Laros, Gerald S.

doi:10.1097/00007632-198710000-00009

Cited by 482 publications

(33 citation statements)

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“…Blikra [6] reported that patients experienced relief from low back pain after removal of herniated lumbar disc material occupying the whole dural sac. McCarron et al [45] suspected a nonmechanical irritation of the dural sac and nerve roots as one of the causes of pain. These authors postulated that tension applied to the dura might produce back pain if an inflammatory response is involved.…”

Section: Introductionmentioning

confidence: 99%

The density of nociceptive SP- and CGRP-immunopositive nerve fibers in the dura mater lumbalis of rats is enhanced after laminectomy, even after application of autologous fat grafts

Saxler¹,

Brankamp²,

Knoch³

et al. 2008

Eur Spine J

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A considerable number of patients complain about pain after lumbar surgery. The spinal dura mater has been debated as a possible source of this pain. However, there is no information if laminectomy influences the nociceptive sensory innervation of the dura. Therefore, we quantitatively evaluated the density of SP-and CGRPimmunopositive nerve fibers in the dura mater lumbalis in an animal model of laminectomy. Twelve adult Lewis rats underwent laminectomy, in six of them the exposed dura was covered by an autologous fat graft. Further six animals without surgical treatment served as controls. Six weeks after surgery, the animals were perfused and the lumbar dura was processed immunohistochemically for the detection of CGRP-and SP-containing nerve fibers. In controls, the peptidergic nerve fibers were found predominantly in the ventral but rarely in the dorsal dura mater lumbalis. After laminectomy, the density of SP-and CGRP-immunopositive neurons significantly increased in ventral as well as in dorsal parts of the dura. Axonal spines could be observed in some cases at the site of laminectomy. The application of autologous fat grafts failed to inhibit the significant increase in the density of peptidergic afferents. Thus, we have provided the first evidence that laminectomies induce an increase in the density of putative nociceptive SP-and CGRP-immunopositive neurons in the lumbar dura mater ascribable to an axonal sprouting of fine nerve fibers. This effect was not prevented by using autologous fat grafts. It is conceivable that the neuronal outgrowth of nociceptive afferents is a cause of low back pain observed after lumbar surgery.

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Section: Introductionmentioning

confidence: 99%

The density of nociceptive SP- and CGRP-immunopositive nerve fibers in the dura mater lumbalis of rats is enhanced after laminectomy, even after application of autologous fat grafts

Saxler¹,

Brankamp²,

Knoch³

et al. 2008

Eur Spine J

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“…Of the 50 patients with a poor outcome at 1 year follow-up (39.4%) only one patient with multiple levels of segmental canal stenosis opted for surgical decompression. The good treatment outcome obtained at 3 months follow-up is due to the capacity of O 2 -O 3 injection into the ganglionic region to normalize the level of cytochines and prostaglandins, increase superoxide dismutase (SOD) and minimize reactive oxygen species (ROS) thereby enhancing local periganglionic circulation with a eutrophic effect on the nerve root [9,10,12,14,15,16,17,18,19]. This effect, however, appears to subside in the long-term, especially when the morphostructural changes to the spine result in continuous pain stimulation.…”

Section: Discussionmentioning

confidence: 99%

Oxygen–Ozone Therapy for Degenerative Spine Disease in the Elderly: A Prospective Study

Bonetti

Fontana

Martinelli

et al. 2010

Acta Neurochirurgica Supplementum

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We describe our experience of oxygen-ozone therapy to treat degenerative spine disease in the elderly. From April 2004 to March 2008 we selected 129 patients with CT and/or MR evidence of spondyloarthrosis and disc degeneration of the lumbar spine. All patients enrolled in the study had contraindications to the administration of commonly used analgesic and anti-inflammatory drugs.Oxygen-ozone therapy was given by CT-guided intraforaminal injection as the first treatment followed by 4 weekly paralumbar infiltrations on an outpatient basis. The full treatment lasted a month. Clinical outcome was assessed 3 months and 1 year after treatment. The good results obtained indicate that oxygen-ozone therapy is an ideal treatment with no side-effects in elderly patients with degenerative spine disease.

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“…Таким образом, патофизиология корешковой боли заключается в том, что у больных с эпидуральным фиброзом атрофируется эпидуральная клетчатка; эпидуральные вены кровенаполнены и варикозно расширены [40]. Образовавшаяся рубцовая ткань фиксирует нервный корешок в определённом положе-нии, повышая его чувствительность к растяжению и компрессии [35].…”

Section: Neurology and Neurosurgeryunclassified

“…Рубцы и спайки компримируют нерв-ные корешки, способствуя нарушению его питания и венозному застою, что приводит к хронизации боли в поясничном отделе позвоночника. Ряд авторов отме-чают важность более выраженной чувствительности к компрессии у спинномозговых корешков, в сравнении с периферическими нервами, так как корешки имеют менее развитый интраневральный сосудисто-нервный барьер, что делает их более уязвимыми к образованию эндоневрального отёка [40,46]. Спинномозговые корешки получают примерно 58 % питательных ве-ществ из окружающей их спинномозговой жидкости, а периневральный фиброз нарушает этот процесс, в связи с чем даже при небольшой дополнительной ком-прессии корешка происходит его ишемия [40,46].…”

Section: Neurology and Neurosurgeryunclassified

“…Ряд авторов отме-чают важность более выраженной чувствительности к компрессии у спинномозговых корешков, в сравнении с периферическими нервами, так как корешки имеют менее развитый интраневральный сосудисто-нервный барьер, что делает их более уязвимыми к образованию эндоневрального отёка [40,46]. Спинномозговые корешки получают примерно 58 % питательных ве-ществ из окружающей их спинномозговой жидкости, а периневральный фиброз нарушает этот процесс, в связи с чем даже при небольшой дополнительной ком-прессии корешка происходит его ишемия [40,46]. Для клиницистов очень важна ранняя диагностика рубцо-во-спаечного процесса в эпидуральном пространстве для разработки своевременной профилактики после-операционного рубцово-спаечного эпидурита и его этиопатогенетического лечения [7].…”

Section: Neurology and Neurosurgeryunclassified

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