Correlation of Tumor Necrosis Factor-α Expression with Pain Level in Degenerative Lumbar Canal Stenosis Patients

Ery Kus Dwianingsih; Yudha Mathan Sakti; Rahadyan Magetsari; David Yosua Parulian Hutahaean; Galih Prasetya Sakadewa; Paramita Dyah Lasmana; Nicolaas C. Budhiparama; Ery Kus Dwianingsih

doi:10.3889/oamjms.2021.6708

Authors

Ery Kus Dwianingsih Department of Pathological Anatomy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia https://orcid.org/0000-0002-0484-7773
Yudha Mathan Sakti Department of Orthopaedics and Traumatology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Rahadyan Magetsari Department of Orthopaedics and Traumatology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
David Yosua Parulian Hutahaean Department of Orthopaedics and Traumatology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Galih Prasetya Sakadewa Department of Orthopaedics and Traumatology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Paramita Dyah Lasmana Department of Orthopaedics and Traumatology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
Nicolaas C. Budhiparama Nicolaas Institute of Constructive Orthopaedic Research and Education Foundation for Arthroplasty and Sports Medicine, Medistra Hospital, Jakarta, Indonesia
Ery Kus Dwianingsih Department of Pathological Anatomy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2021.6708

Keywords:

Tumor necrosis factor-α, Degenerative lumbar canal stenosis, Low back pain

Abstract

Introduction: Pain in degenerative lumbar canal stenosis is caused by osteoarthritis of a facet joint and intervertebral disc degeneration. Some inflammatory mediators such as tumor necrosis factor (TNF)-α are present in degenerative lumbar canal stenosis. This study aimed to evaluate the correlation of pain and functional pre-operative scores with the expression of TNF-α in nucleus pulposus, annulus fibrosus, and facet joint.

Methods: Patients diagnosed with degenerative lumbar canal stenosis and planned for surgical treatment were included in this study. Patients with history of fracture, neoplasm, and/or infection of the spine were excluded. Tissue samples were collected from the nucleus pulposus, annulus fibrosus, facet joint, flavum ligament and paraspinal muscles of the spine during the surgery. TNF-α expression was examined semi-quantitively and correlated with the axial and radicular pain that were measured using Visual Analog Score (VAS) score. The result was then statistically analyzed.

Results: The expression of TNF-α in the paraspinal muscle (6.30±14.20) was significantly higher compared to other locations. TNF-α expression in the facet joint group was significantly correlated with the intensity of low back pain measured by VAS score (r=0.893, p < 0.001), and pre-operative functional outcome based on Oswestry Disability Index (ODI) (r=0.948, p < 0.001).

Conclusion: TNF-α expression, especially in the facet joint, is significantly associated with the pain intensity and pre-operative ODI that allow pain reduction with less invasive treatment in lumbar canal stenosis patients.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Igarashi A, Kikuchi S, Konno S. Correlation between inflammatory cytokines released from the lumbar facet joint tissue and symptoms in degenerative lumbar spinal disorders. J Orthop Sci. 2007;12(2):154. https://doi.org/10.1007/s00776-006-1105-y PMid:17393271 DOI: https://doi.org/10.1007/s00776-006-1105-y

Moe KT, Khairunnisa K, Yin NO, Chin-Dusting J, Wong P, Wong MC. Tumor necrosis factor α-induced nuclear factor-kappaB activation in human cardiomyocytes is mediated by NADPH oxidase. J Physiol Biochem. 2014;70(3):769-79. https://doi.org/10.1007/s13105-014-0345-0 PMid:25059721 DOI: https://doi.org/10.1007/s13105-014-0345-0

Johnson ZI, Schoepflin ZR, Choi H, Shapiro IM, Risbud MV. Disc in flames: Roles of TNF-α _and IL-1β _in intervertebral disc degeneration. Eur Cell Mater. 2015;30:104. https://doi.org/10.22203/ecm.v030a08 PMid:26388614 DOI: https://doi.org/10.22203/eCM.v030a08

Igarashi A, Kikuchi S, Konno S, Olmarker K. Inflammatory cytokines released from the facet joint tissue in degenerative lumbar spinal disorders. Spine. 2004;29(19):2091-5. https://doi.org/10.1097/01.brs.0000141265.55411.30 PMid:15454697 DOI: https://doi.org/10.1097/01.brs.0000141265.55411.30

Whitfield PC, Gherle MS. Treatment options and pathophysiology of degenerative spine disease. Surgery 2018;36(7):362-9. https://doi.org/10.1016/j.mpsur.2018.04.006 DOI: https://doi.org/10.1016/j.mpsur.2018.04.006

Khan AN, Jacobsen HE, Khan J, Filippi CG, Levine M, Lehman RA Jr., et al. Inflammatory biomarkers of low back pain and disc degeneration: A review. Ann N Y Acad Sci. 2017;1410(1):68-84. https://doi.org/10.1111/nyas.13551 PMid:29265416 DOI: https://doi.org/10.1111/nyas.13551

Sutovsky J, Benco M, Sutovska M, Kocmalova M, Pappova L, Miklusica J, et al. Cytokine and chemokine profile changes in patients with lower segment lumbar degenerative spondylolisthesis. Int J Surg. 2017;43:163-70. https://doi.org/10.1016/j.ijsu.2017.06.024 PMid:28600230 DOI: https://doi.org/10.1016/j.ijsu.2017.06.024

Zhang Y, Xu H, Hu X, Zhang C, Chu T, Zhou Y, et al. Histopathological changes in supraspinous ligaments, ligamentum flava and paraspinal muscle tissues of patients with ankylosing spondylitis. Int J Rheum Dis. 2016;19(4):420-9. https://doi.org/10.1111/1756-185x.12305 PMid:24597761 DOI: https://doi.org/10.1111/1756-185X.12305

Zhang C, Chen Z, Meng X, Li M, Zhang L, Huang A. The involvement and possible mechanism of pro-inflammatory tumor necrosis factor alpha (TNF-α) in thoracic ossification of the ligamentum flavum. PLoS One 2017;12(6):e0178986. https://doi.org/10.1371/journal.pone.0178986 PMid:28575129 DOI: https://doi.org/10.1371/journal.pone.0178986

Boddeke EW. Involvement of chemokines in pain. Eur J Pharmacol. 2001;429(1-3):115-9. PMid:11698032 DOI: https://doi.org/10.1016/S0014-2999(01)01311-5

Tobinick EL, Britschgi-Davoodifar S. Perispinal TNF-alpha inhibition for discogenic pain. Swiss Med Wkly. 2003;133(11-12):170-7. PMid:12715286

Lewandrowski KU. Successful outcome after outpatient transforaminal decompression for lumbar foraminal and lateral recess stenosis: The positive predictive value of diagnostic epidural steroid injection. Clin Neurol Neurosurg. 2018;173:38-45. https://doi.org/10.1016/j.clineuro.2018.07.015 PMid:30075346 DOI: https://doi.org/10.1016/j.clineuro.2018.07.015

Ter Meulen BC, Maas ET, Vyas A, van der Vegt M, de Priester K, de Boer MR, et al. Treatment of acute sciatica with transforaminal epidural corticosteroids and local anesthetic: Design of a randomized controlled trial. BMC Musculoskelet Disord. 2017;18:215. https://doi.org/10.1186/s12891-017-1571-8 PMid:28545491 DOI: https://doi.org/10.1186/s12891-017-1571-8

Bartleson JD, Maus TP. Diagnostic and therapeutic spinal interventions: Facet joint interventions. Neurol Clin Pract. 2014;4(4):342-6. https://doi.org/10.1212/cpj.0000000000000044 PMid:29473559 DOI: https://doi.org/10.1212/CPJ.0000000000000044