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Hiyama A, Sakai D, Sato M, Watanabe M. Analysis of intervertebral disc CCR6 and IL-6 gene levels with short-term postoperative low back pain after spinal fusion in lumbar degenerative disease. JOR Spine 2023; 6:e1252. [PMID: 37361330 PMCID: PMC10285749 DOI: 10.1002/jsp2.1252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/08/2023] [Accepted: 02/11/2023] [Indexed: 06/28/2023] Open
Abstract
Background Previous studies have reported that specific pro-inflammatory cytokines or chemokines are more highly expressed in painful than in nonpainful intervertebral discs (IVDs). However, few studies have investigated their correlation with postsurgical outcomes or the relationship between postoperative pain and inflammatory cytokines in IVDs. Thus, the present study examined the correlation among the gene expression levels of pro-inflammatory cytokines and chemokines in IVD tissues removed during surgery and low back pain (LBP), leg pain (LP), and leg numbness (LN) at one year after spinal fusion surgery in patients with a lumbar degenerative disease (LDD). Methods Chemokine and cytokine gene expression levels were measured in IVD samples from 48 patients with LDD. The associations between chemokine and cytokine gene expression levels and pain intensity (numeric rating scale [NRS]) were also analyzed. A correlation analysis was performed between gene expression in each IVD and preoperative and postoperative pain intensity. Results In the preoperative analysis, CCR6 was associated with NRSLBP (r = -0.291, P = 0.045). Postoperative pain analysis revealed correlations between postoperative NRSLBP and CCR6 (r = -0.328, P = 0.023) and between postoperative NRSLBP and IL-6 (r = -0.382, P = 0.007). Furthermore, patients with high postoperative LBP intensity (NRSLBP ≥ 7) also had high LBP intensity (NRSLBP ≥ 6) before surgery, and a correlation was observed (r = 0.418, P = 0.003). None of the gene mRNAs correlated with NRSLP or NRSLN, respectively. Conclusions CCR6 and IL-6 gene expression in the IVD was associated with postoperative LBP intensity and may indicate a need for postoperative pain management.
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Affiliation(s)
- Akihiko Hiyama
- Department of Orthopaedic SurgerySurgical Science, Tokai University School of MedicineIseharaKanagawaJapan
| | - Daisuke Sakai
- Department of Orthopaedic SurgerySurgical Science, Tokai University School of MedicineIseharaKanagawaJapan
| | - Masato Sato
- Department of Orthopaedic SurgerySurgical Science, Tokai University School of MedicineIseharaKanagawaJapan
| | - Masahiko Watanabe
- Department of Orthopaedic SurgerySurgical Science, Tokai University School of MedicineIseharaKanagawaJapan
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Kong L, Gao L, Zhang H, Wang X, Zhang J. Does Preoperative Hookwire Localization Influence Postoperative Acute and Chronic Pain After Video-Assisted Thoracoscopic Surgery: A Prospective Cohort Study. J Pain Res 2023; 16:21-32. [PMID: 36636265 PMCID: PMC9830704 DOI: 10.2147/jpr.s387543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/24/2022] [Indexed: 01/05/2023] Open
Abstract
Purpose This study aimed to investigate whether preoperative computerized tomography-guided hookwire localization-associated pain could affect acute and chronic postsurgical pain (CPSP) in patients undergoing video-assisted thoracoscopic surgery (VATS). Methods We enrolled 161 adult patients who underwent elective VATS; sixty-nine patients experienced hookwire localization (Group A) and 69 did not (Group B). Group A was further subdivided into the multiple localization group (n=35, Group Amultiple) and the single localization group (n=34, Group Asingle) according to the number of hookwires. The numerical rating scale (NRS) was used preoperatively, during recovery at the post-anesthesia care unit (PACU), and the first two days, 3 and 6 months postoperatively. Furthermore, multivariate regression analysis was used to identify the risk factors associated with CPSP. The postoperative adverse events, length of hospital stay, and satisfaction in pain management were also recorded. Results The incidence and severity of acute postoperative pain were similar between Group A and Group B (p > 0.05). The incidence (56.5% vs 30.4%, p = 0.002) and the NRS scores (2.0 [2.0-3.0] vs 1.0 [1.0-2.0], p = 0.011) for CPSP were significantly higher in Group A than in Group B at 3 months postoperatively. On subgroup analysis, compared with Group Asingle, the intensity of CPSP (2.0 [2.0-3.0] vs 2.0 [1.0-2.0], p = 0.005) in Group Amultiple was slightly higher at 3 months postoperatively. Conversely, the CPSP incidence (60.0% vs 29.4%, p = 0.011) was significantly higher at 6 months postoperatively in Group Amultiple. The multivariate regression analysis further validated hookwire localization as a risk factor for CPSP (odds ratio: 6.199, 95% confidence interval 2.049-18.749, p = 0.001). Patient satisfaction relating to pain management at 3 months postoperatively was lower in Group A (p = 0.034). Conclusion The preoperative pain stress of hookwire localization increased the incidence and intensity of CPSP rather than acute pain at 3 months postoperatively, especially in patients with multiple hookwires.
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Affiliation(s)
- Lingchao Kong
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Lingling Gao
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Hong Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Xin Wang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Jun Zhang
- Department of Anesthesiology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China,Correspondence: Jun Zhang, Department of Anesthesiology, Shanghai Cancer Center, Fudan University and Department of Oncology, Shanghai Medical College, Fudan University, No. 270 Dong’An Road, Xuhui District, Shanghai, 200032, People’s Republic of China, Tel +86-21-64175590, Fax +86-21-64174774, Email
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Han ML, He WH, He ZY, Yan XL, Fang XJ. Anatomical characteristics affecting the surgical approach of oblique lateral lumbar interbody fusion: an MR-based observational study. J Orthop Surg Res 2022; 17:426. [PMID: 36153543 PMCID: PMC9509567 DOI: 10.1186/s13018-022-03322-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Oblique lateral lumbar interbody fusion (OLIF) is one of the most widely used lumbar interbody fusion procedures in clinical practice. The aim of this study was to minimize the incidence rate of surgical complications by measuring the anatomical parameters of structures surrounding the working channels of OLIF with 3D COSMIC sequence.
Methods The MRI examination included conventional MRI sequence and 3D COSMIC sequence. Surgical window, psoas thickness, the transverse diameter of the endplate, and nerve distance were measured to evaluate the anatomical characteristics surrounding the OLIF working channels.
Results The widths of the natural surgical window at the level of the L2–3, L3–4, and L4–5 intervertebral measured in this study were 16.25 ± 4.22, 15.46 ± 4.64 mm, and 11.71 ± 6.29 mm, respectively. The average thickness of the left psoas major muscle at the level of L2–3, L3–4, and L4–5 intervertebral space was 28.42 ± 5.08 mm, 30.76 ± 5.84 mm, and 31.16 ± 7.72 mm, respectively. The mean value of insertion angle (β) was 45.57° ± 6.19° in L2–3 intervertebral space, 49.90° ± 6.53° in L3–4 intervertebral space, and 43.34° ± 8.88° in L4–5 intervertebral space. Conclusions The 3D COSMIC sequences can be used for imaging anatomical assessment before OLIF surgery. In preoperative planning, the 3D COSMIC sequence can be used to measure the relevant parameters mentioned above to optimize the planned surgical approach.
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