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Low back pain scores correlate with the cytokine mRNA level in lumbar disc biopsies: a study of inflammatory markers in patients undergoing lumbar spinal fusion

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Abstract

Purpose

The molecular mechanism behind pain in degenerative disc disease (DDD) and chronic low back pain (LBP) patients is largely unknown. This present study examines the association of LBP and disability to mediators of the inflammatory cascade, as indexed by mRNA gene expression of pro-inflammatory cytokine markers in the intervertebral disc (IVD).

Methods

Biopsies of the annulus fibrosus (AF) and the nucleus pulposes (NP) from patients with DDD undergoing 1–2 level fusion surgery at L4/L5 or L5/S1 were obtained from total of 34 patients [9 M, 25 F] with average age of 53 [32–63]. The mRNA expression of TNF-α, IL-1β, and IL-6 in the AF and NP was analyzed using quantitative real-time polymerase chain reaction (RT-qPCR), and the expression level of these markers was correlated to the visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores (0–100) for pain and disability.

Results

We report a statistically significant positive correlation between pain intensity (VAS score) and the expression of TNF-α in both the AF (r = 0.54, p = 0.001) and NP (r = 0.40, p = 0.02), similarly with IL-1β in AF (r = 0.37, p = 0.02) and IL-6 in NP (r = 0.40, p = 0.02). In addition, we found significant positive correlation observed between disability score (ODI) and expression of IL-6 in both AF (r = 0.36, p = 0.03) and NP (r = 0.41, p = 0.01).

Conclusion

We conclude that the intensity of LBP and disability is associated with the level of inflammation in the disc.

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Acknowledgements

The authors gratefully acknowledge the financial support from the Gigtforeningen and Elsass Foundation.

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Authors and Affiliations

  1. Neurobiology Research Unit, University Hospital Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Sanjay S. Aripaka, L. M. Jørgensen & J. D. Mikkelsen

  2. Copenhagen Spine Research Unit, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark

    R. Bech-Azeddine, L. M. Jørgensen, S. A. Chughtai, C. Gaarde & T. Bendix

  3. Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    R. Bech-Azeddine, L. M. Jørgensen & J. D. Mikkelsen

  4. Department of Neuroscience, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    J. D. Mikkelsen

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  1. Sanjay S. Aripaka
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Correspondence to J. D. Mikkelsen.

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The study was approved by the Danish ethics committee (H-17026301). All participants provided written informed consent according to the Declaration of Helsinki.

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Aripaka, S.S., Bech-Azeddine, R., Jørgensen, L.M. et al. Low back pain scores correlate with the cytokine mRNA level in lumbar disc biopsies: a study of inflammatory markers in patients undergoing lumbar spinal fusion. Eur Spine J 30, 2967–2974 (2021). https://doi.org/10.1007/s00586-021-06868-3

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