title: Lumbar posterolateral fusion inhibits sensory nerve ingrowth into punctured lumbar intervertebral discs and upregulation of CGRP immunoreactive DRG neuron innervating punctured discs in rats.
abstract: Degeneration of lumbar intervertebral discs is thought to be a cause of low back pain. Studies have found that a cause of discogenic low back pain is intervertebral disc inflammation and axonal growth of afferent fibers innervating the disc. Lumbar spine fusion for chronic discogenic low back pain is considered an effective procedure. However, no study has investigated the mechanism of pain relief. We did this by applying Fluoro-Gold (FG) to the ventral aspect of the L4-L5 intervertebral discs of 40 rats. We exposed the nucleus pulposus to the annulus fibrosus in a disc punctured model. Rats were divided into 4 groups. Group A: Punctured intervertebral disc with sham posterolateral fusion (PLF) (n = 10), Group B: Punctured intervertebral disc with PLF (n = 15), Group C: Normal intervertebral disc (no puncture) with PLF (n = 10), and Group D: Normal disc (no disc puncture) with sham PLF (n = 5). Four weeks after surgery, bilateral L1-L5 dorsal root ganglia (DRGs) were stained with growth-associated protein 43 (GAP43), a marker of axonal growth, and calcitonin gene-related peptide (CGRP), a neuropeptide marker of pain. Bone union was evaluated using X-ray imaging. Of the FG-labeled neurons, the proportions of GAP43- and CGRP-immunoreactive (IR) neurons in Group A were significantly higher than in Group D (P < 0.05). The proportions of GAP43- and CGRP-IR neurons in bone union rats in Group B were significantly lower than in nonunion rats in Group B and in the rats in Group A (P < 0.05). No significant differences in GAP43- and CGRP-IR neurons were observed between bone union and nonunion rats in Group C and the rats in Group D (P > 0.05). PLF is strongly related to the downregulation of GAP43 and CGRP expression. Therefore, PLF may suppress the increase of inflammatory neuropeptides and the process of axonal growth. Moreover, these results may explain, in part, the mechanism of pain relief following lumbar spinal fusion for chronic discogenic low back pain in humans.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan. kosu@xj8.so-net.ne.jp
authors.forename: Takana
authors.initials: T
authors.lastname: Koshi
authors.forename: Seiji
authors.initials: S
authors.lastname: Ohtori
authors.forename: Gen
authors.initials: G
authors.lastname: Inoue
authors.forename: Toshinori
authors.initials: T
authors.lastname: Ito
authors.forename: Masaomi
authors.initials: M
authors.lastname: Yamashita
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Yamauchi
authors.forename: Munetaka
authors.initials: M
authors.lastname: Suzuki
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Aoki
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D015740:Calcitonin Gene-Related Peptide / Q000378:metabolism*; D004195:Disease Models, Animal; D019922:GAP-43 Protein / Q000378:metabolism; D005727:Ganglia, Spinal / Q000378:metabolism*; D007150:Immunohistochemistry; D007403:Intervertebral Disc / Q000294:innervation / Q000378:metabolism; D055959:Intervertebral Disc Degeneration / Q000378:metabolism / Q000601:surgery*; D017116:Low Back Pain / Q000378:metabolism; D008159:Lumbar Vertebrae / Q000294:innervation / Q000378:metabolism / Q000601:surgery*; D008297:Male; D009416:Nerve Regeneration / Q000502:physiology*; D051381:Rats; D017207:Rats, Sprague-Dawley; D011984:Sensory Receptor Cells / Q000378:metabolism* / Q000502:physiology; D013123:Spinal Fusion
chemical_list: D019922:GAP-43 Protein; D015740:Calcitonin Gene-Related Peptide