Markers of inflammation and fibrinolysis in relation to outcome after surgery for lumbar disc herniation. A prospective study on 177 patients

Elkan, Peter; Sten-Linder, Margareta; Hedlund, Rune; Willers, U.; Ponzer, Sari; Gerdhem, Paul

doi:10.1007/s00586-015-3998-7

Cited by 17 publications

(12 citation statements)

References 130 publications

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“…Positive changes include an increase in working hours or re-employment TED [29] has important implications for longer-term outcomes in terms of the ease of revision surgery. The reduction in tissue disruption provided by the TED technique may also have important effects on outcome via a reduction in cytokine release lessening the overall inflammatory response to surgery [30]. In this trial, patients who underwent revision were included in our outcome data only up to the point of revision.…”

Section: Discussionmentioning

confidence: 99%

A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy

2016

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Purpose Transforaminal endoscopic discectomy (TED) minimises paraspinal muscle damage. The aim of this trial was to compare clinical outcomes of TED to Microdiscectomy (Micro). Methods 143 patients, age 25-70 years and \115 kg, with single level lumbar prolapse and radiculopathy, were recruited and randomised. 70 received TED under conscious sedation and 70 Micro under general anaesthesia. Oswestry Disability Index (ODI), visual analogue scores (VAS) of back and leg pain, and Short Form Health Survey indices (SF-36) were measured preoperatively and at 3, 12 and 24 months. Results All outcome measures improved significantly in both groups (p \ 0.001). Affected side leg pain was lower in the TED group at 2 years (1.9 ± 2.6 vs 3.5 ± 3.1, p = 0.002). Hospital stay was shorter following TED (0.7 ± 0.7 vs 1.4 ± 1.3 days, p \ 0.001). Two Micro patients and five TED patients required revision giving a relative risk of revision for TED of 2.62 (95% CI 0.49-14.0). Conclusions Functional improvements were maintained at 2 years in both groups with less ongoing sciatica after TED. A greater revision rate after TED was offset by a more rapid recovery.

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Section: Discussionmentioning

confidence: 99%

A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy

2016

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“…On a more mechanistic approach, finding molecular markers, possibly noninvasive ones, such as systemic markers, to predict the outcome of LDH would have a major impact on the clinical decision. These approaches are only starting to emerge, such as the study by Elkan et al [ 23 ] in which high plasminogen activator inhibitor 1, a marker of fibrinolysis, analyzed in blood samples of patients with LDH, was fairly consistently associated with poor LDH surgery outcome.…”

Section: Clinical Evidence Of Spontaneous Ldh Regressionmentioning

confidence: 99%

The inflammatory response in the regression of lumbar disc herniation

et al. 2018

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Lumbar disc herniation (LDH) is highly associated with inflammation in the context of low back pain. Currently, inflammation is associated with adverse symptoms related to the stimulation of nerve fibers that may lead to pain. However, inflammation has also been indicated as the main factor responsible for LDH regression. This apparent controversy places inflammation as a good prognostic indicator of spontaneous regression of LDH. This review addresses the molecular and cellular mechanisms involved in LDH regression, including matrix remodeling and neovascularization, in the scope of the clinical decision on conservative versus surgical intervention. Based on the evidence, a special focus on the inflammatory response in the LDH context is given, particularly in the monocyte/macrophage role. The phenomenon of spontaneous regression of LDH, extensively reported in the literature, is therefore analyzed here under the perspective of the modulatory role of inflammation.

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“…The prospective observational study, LDHS, included patients admitted for lumbar disc herniation surgery at Södersjukhuset, Stockholm, Sweden. Details of the study have been presented earlier [7]. Inclusion criteria were: one-level paramedian or central lumbar disc herniation, radiculopathy with corresponding MRI finding, a duration of more than 2 months, or earlier if requiring hospitalization, a need for 25% or more of sick leave or similar disability, and an age of 18 years or older.…”

Section: Lumbar Disc Herniation Studymentioning

confidence: 99%

Response rate does not affect patient-reported outcome after lumbar discectomy

et al. 2018

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Markers of inflammation and fibrinolysis in relation to outcome after surgery for lumbar disc herniation. A prospective study on 177 patients

Abstract: High PAI-1, a marker of fibrinolysis, was fairly consistently associated with poor outcome, while hsCRP, fibrinogen, and D-dimer were not.

Cited by 17 publications

References 130 publications

A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy

A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy

The inflammatory response in the regression of lumbar disc herniation

Response rate does not affect patient-reported outcome after lumbar discectomy

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