Markers of nerve tissue injury in the cerebrospinal fluid in patients with lumbar disc herniation and sciatica.
METHODS
The light subunit of neurofilament protein, S-100 protein, neuron-specific enolase, and glial fibrillary acidic protein were determined in the cerebrospinal fluid in patients with lumbar disc herniation and in control patients.


OBJECTIVE
To determine whether nerve root injury caused by disc herniation increases the levels of nerve and glial cell injury markers in the cerebrospinal fluid.


BACKGROUND
Markers of nerve tissue injury can be analyzed in the cerebrospinal fluid, allowing characterization of the cell types involved and the degree of disease in patients with neurologic disorders.


METHODS
Cerebrospinal fluid samples were obtained by preoperative lumbar puncture in patients who underwent surgery for lumbar disc herniation and in patients who underwent lower extremity surgery (control group), neurofilament protein (light subunit) and glial fibrillary acidic protein were analyzed by enzyme-linked immunosorbent assay and S-100 protein and neuron-specific enolase by radioimmunoassay and luminescence immunoassay, respectively. In the disc herniation group the concentrations of the four markers were evaluated regarding possible correlation to patient history, computed tomographic findings, and clinical findings.


RESULTS
Cerebrospinal fluid concentration of neurofilament protein (light subunit) and S-100 were increased in the disc herniation group compared with that in control subjects (1158 +/- 383 ng/L vs. 152 +/- 14 ng/L, P < 0.01; 1963 +/- 231 ng/L vs. 1003 +/- 152 ng/L, P < 0.05, respectively). No statistical differences in neuron-specific enolase and glial fibrillary acidic protein concentrations were observed between the groups. Disc herniation patients with fewer than 3 months' duration of subjective symptoms had higher neurofilament protein levels than did patients with longer duration. None of the markers was related to preoperative clinical or computed tomographic findings. Patients with persistent neurologic findings at follow-up 2-3 months after surgery had higher levels of neurofilament protein before surgery compared with-those without sequelae.


CONCLUSIONS
Patients with disc herniation and sciatica have increased concentrations of neurofilament protein and S-100 in the cerebrospinal fluid, which indicates damage of axons and Schwann cells in the affected nerve root.
Brisby
H
H
Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg University, Sweden. Helena.Brisby@orthop.gu.se
Olmarker
K
K
Rosengren
L
L
Cederlund
C G
CG
Rydevik
B
B
D000328:Adult; D015415:Biomarkers / Q000134:cerebrospinal fluid; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D005904:Glial Fibrillary Acidic Protein / Q000134:cerebrospinal fluid*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000134:cerebrospinal fluid* / Q000000981:diagnostic imaging; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D016900:Neurofilament Proteins / Q000134:cerebrospinal fluid*; D009457:Neuroglia / Q000378:metabolism; D010751:Phosphopyruvate Hydratase / Q000134:cerebrospinal fluid*; D011379:Prognosis; D011863:Radioimmunoassay; D009418:S100 Proteins / Q000134:cerebrospinal fluid*; D012585:Sciatica / Q000134:cerebrospinal fluid* / Q000000981:diagnostic imaging; D013126:Spinal Nerve Roots / Q000293:injuries / Q000378:metabolism; D014057:Tomography, X-Ray Computed
D015415:Biomarkers; D005904:Glial Fibrillary Acidic Protein; D016900:Neurofilament Proteins; D009418:S100 Proteins; D010751:Phosphopyruvate Hydratase