This study was designed to characterize the effects of low doses (0.5-5 ng) of pro-inflammatory cytokines, interleukin-1 beta (IL-1beta), interleukin-6 (IL-6), and tumor necrosis factor (TNF), on the neural activity of dorsal root ganglion (DRG) in rats. The purpose of this study was to examine the effects of cytokines (IL-1beta, IL-6, and TNF) on the somatosensory neural response of DRG. The release of inflammatory cytokines by an injured disc may play a critical role in pain production at nerve endings, axons, and nerve cell bodies. Herniated disc tissue has been shown to release IL-1beta, IL-6, TNF, and other algesic chemicals. Their effects on nerve endings in disc and adjacent tissue may lead to low back pain and their effects on dorsal root axons and ganglia may lead to sciatica. Exposed lumbar DRGs were investigated by electrophysiologic techniques. Sham (mineral oil), control (carrier solution), or IL-1beta, IL-6, or TNF at doses of 0.5, 1, and 5 ng were applied over the DRG. Baseline discharge rates as well as mechanosensitivity of the DRG and peripheral receptive fields were evaluated over 30 min. Applications of IL-1beta at 1 ng resulted in an increase in the discharge rate, 5 ng resulted in an increased mechanosensitivity of the DRG in group II units. Similarly, after 1 ng TNF applications, group II units also showed an increase in mechanosensitivity of DRG and peripheral receptive fields. At low doses IL-1beta and TNF sensitization of receptive fields were observed. The responses observed in the group II units indicate that a sub-population of afferent units might have long-term effects modifying the sensory input to the central nervous system. This study provides added evidence to the role of cytokines in modulating afferent activity following inflammation.
The release of inflammatory cytokines caused by a disrupted disc may play a critical role in pain production at nerve endings, axons, and nerve cell bodies. Herniated disc tissue has been shown to release inflammatory cytokines such as interleukin-1 beta (IL-1beta), interleukin-6 (IL-6), tumor necrosis factor (TNF), and other algesic chemicals. This study was designed to characterize the effects of these proinflammatory cytokines on the somatosensory neural response at the dorsal root level in rats. It is hypothesized that their effects on nerve endings in disc and adjacent tissue contribute to low-back pain, and the effects on dorsal root axons and ganglia contribute to radiculopathy and sciatica. Surgically isolated sacral dorsal roots were investigated by electrophysiologic techniques. IL-1beta, IL-6, or TNF (100 ng, each) were applied onto the dorsal roots. Neural responses and mechanosensitivity of the receptive fields were evaluated over time. The results showed that 3 h after each cytokine application, the neural activity was statistically decreased. The mechanical sensitivity of the receptive fields increased at 90 min following IL-1beta or TNF application, and returned to normal more than 3 h after IL-1beta application. IL-1beta, IL-6, and TNF may be neurotoxic to dorsal root axons. Furthermore IL-1beta and TNF may sensitize the peripheral receptive fields. This study suggests that dorsal roots may be impaired by these proinflammatory cytokines.
Backgraund and Aim: We aimed to compare the results of the treatment of the patients with failed back surgery syndrome (FBSS) by mechanical lysis and steroid hylase injection via epiduroscopy due to their stabilization status and to detect the effect of pathological diagnostic markers on prognosis and ongoing tretment protocol. Methods: Eighty-two patients with FBSS symtoms were included. Two groups were composed as group I (stabilized) and group II (non-stabilized). All patients were evaluated using the oswestry disability index (ODI) and visual analogue scale (VAS) scores before and after treatment at 1, 3, 6, and 12 months and using the Patient Satisfaction Scale at 12 months following treatment. Epidural scar tissue visual and mechanical signs were also recorded. Results: Mean VAS scores were as 7.8 and 3.28 points in group I (p<0.001) and as 7.51 and 2.74 points in group II (p<0.001) at the beginning and 12th months, respectively. Mean ODI scores were as 34.05 and 22.16 points in group I (p<0.001) and as 30.74 and 19.46 points in group II (p<0.001) at the beginning and 12th months. VAS and ODI scores decreased significantly in both groups, but were more significant in non-stabilized group (p<0.001). Moderate or severe fibrous tissue was observed in 86.58% and patient satisfaction scores were very good or good in 78.06%. During the procedure, a dura rupture developed in four patients in the stabilization group and in two patients in the non-stabilization group, although none of these patients developed a spinal headache, and no significant permanent complication arose. Conclusion: We suggest that epidural adhesiolysis, hyaluronidase and steroid injection in patients with FBSS chronic low back pain and/or radicular symptoms may give reliable information about the quality of life, accuracy of diagnosis and the possible course of the present findings and may be more effective in unstabilized patients. Key Words: Failed back surgery syndrome, epiduroscopic adhesiolysis, hyaluronidase.
We found a highly variable thickness of the LC muscle in anatomic and imaging studies, which may lead to negative block results.
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