Abstract
Inflammatory mechanisms have been suggested to be involved in the basic pathophysiologic events leading to nerve root injury after local application of nucleus pulposus. To assess if these nucleus pulposus-induced effects could be blocked by anti-inflammatory treatment, 41 dogs were exposed to either incision of the L6-7 disc to induce experimental disc herniation with (n=12) or without (n=14) indomethacin treatment per os (5 mg/kg per day), and no incision with (n=5) or without (n=10) indomethacin. Intraneural blood flow and nerve conduction velocity were assessed after 7 days to evaluate the degree of nerve injury. Disc incision induced a reduction in nerve root and dorsal ganglion blood flow as well as nerve function, similarly to previous studies. However, simultaneous treatment with indomethacin efficiently blocked the negative effects on both blood flow and nerve conduction but had no effects per se. The present study thus indicates that inflammatory mechanisms may be of relevance in the pathophysiology of nucleus pulposus-induced nerve root injury and thereby also for sciatica.
Keywords: Sciatica, Disc herniation, Nerve roots, Inflammation, Inflammatory mediators
Footnotes
This study was supported by grants from the Fukushima Medical Research Promotion Foundation and the Swedish Medical Research Council (9758)
References
- 1.Byröd G, Olmarker K, Konno S, Larsson K, Takahashi K, Rydevik B. A rapid transport route between the epidural space and the intraneural capillaries of the nerve roots. Spine. 1995;20:138–143. doi: 10.1097/00007632-199512151-00010. [DOI] [PubMed] [Google Scholar]
- 2.Byröd G, Olmarker K, Nordborg C, Rydevik B. Early effects of nucleus pulposus application on spinal nerve root morphology and function. Eur Spine J. 1998;7:445–449. doi: 10.1007/s005860050106. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Grönblad M, Virri J, Tolonen J, et al. A controlled immunohisto-chemical study of inflammatory cells in disc herniation tissue. Spine. 1994;19:2744–2751. doi: 10.1097/00007632-199412150-00002. [DOI] [PubMed] [Google Scholar]
- 4.Grönblad M, Virri J, Rankko S, et al. A controlled biochemical and immunohistochemical study of human synovial type (group II) phospholipase A2 and inflammatory cells in macro-scopically normal, degenerated and herniated lumbar disc tissues. Spine. 1996;21:2531–2538. doi: 10.1097/00007632-199611150-00001. [DOI] [PubMed] [Google Scholar]
- 5.Kayama S, Konno S, Olmarker K, Yabuki S, Kikuchi S. Incision of the annulus fibrosus induces nerve root morphologic, vascular and functional changes. Spine. 1996;21:2539–2543. doi: 10.1097/00007632-199611150-00002. [DOI] [PubMed] [Google Scholar]
- 6.Kayama S, Olmarker K, Larsson K, Sjögren-Jansson E, Lindahl A, Rydevi B. Cultured, autologous nucleus pulposus cells induce functional changes in spinal nerve roots. Spine. 1998;23(20):2155–2158. doi: 10.1097/00007632-199810150-00002. [DOI] [PubMed] [Google Scholar]
- 7.Korbine AI, Doyle TF, Martins AN. Spinal cord blood flow in the rhesus monkey by the hydrogen clearance method. Surg Neurol. 1974;2:192–200. [PubMed] [Google Scholar]
- 8.McCarron RF, Wimpee MW, Hudkins P, Laros GS. The inflammatory effect of nucleus pulposus. A possible element in the pathogenesis of low-back pain. Spine. 1987;12:760–764. doi: 10.1097/00007632-198710000-00009. [DOI] [PubMed] [Google Scholar]
- 9.Myers RR, Murakami H, Powell HC. Reduced nerve blood flow in edematous neuropathies: a biomechanical mechanism. Microvasc Res. 1986;32:145–151. doi: 10.1016/0026-2862(86)90050-6. [DOI] [PubMed] [Google Scholar]
- 10.Olmarker K, Rydevik B, Nordborg C. Autologous nucleus pulposus induces neurophysiologic and histologic changes in porcine cauda equina nerve roots. Spine. 1993;18:1425–1432. doi: 10.1097/00007632-199318110-00005. [DOI] [PubMed] [Google Scholar]
- 11.Olmarker K, Byröd G, Cornefjord M, Nordborg C, Rydevik B. Effects of methyl-prednisolone on nucleus pulposus-induced nerve root injury. Spine. 1994;19:1803–1808. doi: 10.1097/00007632-199408150-00003. [DOI] [PubMed] [Google Scholar]
- 12.Olmarker K, Blomquist J, Strömberg J, Nannmark U, Thomsen P, Rydevik B. Inflammatogenic properties of nucleus pulposus. Spine. 1995;20:665–669. doi: 10.1097/00007632-199503150-00006. [DOI] [PubMed] [Google Scholar]
- 13.Olmarker K, Rydevik B, Nordborg C. Ultrastructural changes in spinal nerve roots induced by autologous nucleus pulposus. Spine. 1996;21:411–414. doi: 10.1097/00007632-199602150-00002. [DOI] [PubMed] [Google Scholar]
- 14.Otani K, Kikuchi S, Arai I, Mao GP, Konno S, Olmarker K. Experimental disc herniation. Evaluation of the natural course using assessment of changes in nerve conduction of the spinal nerve roots and MRI changes of the intervertebral discs. Spine. 1997;22:2894–2899. doi: 10.1097/00007632-199712150-00012. [DOI] [PubMed] [Google Scholar]
- 15.Otani K, Arai I, Mao GP, Konno S, Olmarker K, Kikuchi S: Nucleus pulposus-induced nerve root injury. The relationship between blood flow and nerve conduction velocity. Neurosurgery 45:614–619 [DOI] [PubMed]
- 16.Otani K, Mao GP, Arai I, Konno S, Olmarker K, Kikuchi S. Nucleus pulposus-induced increase in vascular permeability in the nerve root. (Unpublished)
- 17.Rydevik B, Myers RR, Powell HC. Pressure increase in the dorsal root ganglion following mechanical compression. Closed compartment in the nerve root. Spine. 1989;14:574–576. doi: 10.1097/00007632-198906000-00004. [DOI] [PubMed] [Google Scholar]
- 18.Saal JS, Franson RC, Dobrow R, Saal JA, White AH, Goldthwaite N. High levels of inflammatory phospholipase A2 activity in lumbar disc herniations. Spine. 1990;15:674–678. doi: 10.1097/00007632-199007000-00011. [DOI] [PubMed] [Google Scholar]
- 19.Stossec K, Luebbers DW, Cottin N. Determination of local blood flow (micro-flow) by electrochemically generated hydrogen. Construction and application of the measuring probe. Pflugers Arch. 1974;348:225–238. doi: 10.1007/BF00587413. [DOI] [PubMed] [Google Scholar]
- 20.Takino T, Takahashi K, Miyazaki T, Matsui T, Tomita K. An immunohistochemical study of inflammatory cell appearance in rabbits nucleus pulposus. Neuroorthop. 1997;20:113–120. [Google Scholar]