Analysis and prevalence of inflammatory cells in subtypes of lumbar disc herniations under cyclooxygenase-2 inhibitor therapy.
OBJECTIVE
The aim of the present study was to analyse inflammatory cells in lumbar disc tissue under cyclooxygenase-2 (COX-2) inhibitor therapy, to detect their prevalence in different subtypes of lumbar disc herniations and to assess the influence of inflammatory reactions in herniated disc tissue on postoperative outcome.


METHODS
In this prospective study, intervertebral disc specimens were obtained from 50 patients. All the patients were given COX-2 inhibitor therapy (Rofecoxib) 25 mg/day for 10 days before surgery. The herniated disc specimens were routinely fixed in a 10% buffered formaline solution and paraffin-embedded; 5 microm thin sections were stained with monoclonal antibodies CD-68 for macrophages, CD-45 RO for T cells and CD-20 for B cells. The specimens were microscopically examined and classified by two independent examiners in a blinded manner.


RESULTS
CD-68 macrophages were evident in herniated lumbar disc tissue in 40% of the cases, but abundant inflammation was observed in only 18% of the cases. Macrophages were significantly common in sequesters with a prevalence of 80%, and no macrophages were observed in the protrusions. We obtained the best outcome scores in the patients with a sequestrated lumbar disc herniation.


CONCLUSIONS
Although most of the specimens from all the patients showed no significant inflammatory reaction, maybe due to COX-2 inhibitor therapy, they all needed surgery with no relief of the symptoms despite conservative therapy. Nerve root compression still seems to be the leading pathomechanism.
Aydin
M Volkan
MV
Department of Neurosurgery, Medical Faculty, Baskent University, Adana, Turkey. volkan8@hotmail.com
Sen
Orhan
O
Kayaselcuk
Fazilet
F
Bolat
Filiz
F
Tufan
Kadir
K
Caner
Hakan
H
Altinors
Nur
N
D000328:Adult; D000368:Aged; D015703:Antigens, CD / Q000378:metabolism; D018951:Antigens, CD20 / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D001402:B-Lymphocytes / Q000378:metabolism; D016861:Cyclooxygenase Inhibitors / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007150:Immunohistochemistry / Q000379:methods; D007249:Inflammation / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D007783:Lactones / Q000627:therapeutic use*; D017493:Leukocyte Common Antigens / Q000378:metabolism; D008159:Lumbar Vertebrae; D008264:Macrophages / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D013450:Sulfones / Q000627:therapeutic use*; D013601:T-Lymphocytes / Q000378:metabolism; D000097382:CD68 Molecule
D015703:Antigens, CD; D018951:Antigens, CD20; D015214:Antigens, Differentiation, Myelomonocytic; D016861:Cyclooxygenase Inhibitors; D007783:Lactones; D017493:Leukocyte Common Antigens; D013450:Sulfones; C067980:CD68 antigen, human; D000097382:CD68 Molecule; C116926:rofecoxib