Abstract
Amaç: İnflamatuar
mekanizmalar disk hernisi ile ilişkili bel ağrısının patogenezinde önemli bir
rol oynamaktadır. Rutin hemogram testlerindeki yeni ve umut vadeden inflamatuar
markörler ortalama trombosit hacmi (MPV) ve kırmızı küre dağılım genişliği
(RDW)’ dir. Sunulan çalışmada lomber disk hernili hastaların (LDH) MPV
ve RDW değerlerinin sağlıklı gönüllülerle ve lomber disk hernisi açısından
radyolojik bulguları olmayan siyataljili semptomatik hastalarla
karşılaştırılması amaçlanmıştır.
Gereç ve Yöntemler: Sunulan
retrospektif çalışma Abant İzzet Baysal Üniversitesi Eğitim ve Araştırma Hastanesinin
nöroşirürji anabilim dalında gerçekleştirildi. Kontrol (n=57), LDH (n=73) ve
siyatalji (n=20). olmak üzere üç grup
oluşturuldu. Grupların beyaz küre (WBC), hemoglobin (Hb), hematokrit (Htc),
ortalama korpüsküler hacim (MCV), platelet sayısı (PLT), RWD ve MPV parametreleri değerlendirildi.
Bulgular: LDH,
siyatalji ve kontrol gruplarının ortalama MPV değerleri sırasıyla 9.3 ± 1.8 fL,
8.2 ±1.1fL ve 8.4 ±1.0fL olarak bulundu. LDH grubunun ortalama MPV değeri
siyatalji ve kontrol gruplarından önemli derecede daha yüksekti (p=0.001). LDH,
siyatalji ve kontrol gruplarının ortalama RDW değerleri sırasıyla 14.8±1.8, 13.8±1.0
ve 13.7±1.2 olarak bulundu.
LDH grubunun ortalama RDW değeri de siyatalji ve
kontrol gruplarından önemli derecede daha yüksekti (p=0.001).
Tartışma ve Sonuç:
Yükselmiş MPV ve RDW değerleri siyataljili
hastalardaki LDH’ nin güçlü indikatörleri olabilirler ve bu yükselmiş değerlere
sahip hastalar görüntüleme çalışmaları için öncelikli olarak düşünülmelidirler.
Bununla birlikte bulgularımızı destekleyen daha fazla prospektif çalışmaya
ihtiyaç vardır.
References
- 1. Walker BF. The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord. 2000; 13(3): 205-17. 2. Demirdağ F, Ediz L, Özgür A, Tekeoğlu İ. Kronik Lomber Disk Hernili Hastaların Tedavisinde Tens İle Elektroakupunktur Tedavisinin Karşılaştırılması. Van Tıp Dergisi. 2011; 18(1): 15-9. 3. Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012; 64(6): 2028-37. 4. Beyaz SG. Comparison of transforaminal and interlaminar epidural steroid injections for the treatment of chronic lumbar pain. Braz J Anesthesiol. 2017; 67(1): 21-7. 5. Kılıç B. Lumbar Disc Herniation. Adv. Environ Biol. 2015; 9: 44-9. 6. Takahashi H, Suguro T, Okazima Y, Motegi M, Okada Y, Kakiuchi T. Inflammatory cytokines in the herniated disc of the lumbar spine. Spine (Phila Pa 1976). 1996; 21(2): 218-24. 7. Nygaard OP, Mellgren SI, Osterud B. The inflammatory properties of contained and noncontained lumbar disc herniation. Spine (Phila Pa 1976). 1997; 22(21): 2484-8. 8. Saal JS. The Role of Inflammation in Lumbar Pain. Spine (Phila Pa 1976). 1995; 20(16): 1821-7. 9. Goupille P, Jayson MI, Valat JP, Freemont AJ. The role of inflammation in disk herniation-associated radiculopathy. Semin Arthritis Rheum. 1998; 28(1): 60-71. 10. Wehling P, Bandara G, Evans CH. Synovial cytokines impair the function of the sciatic nerve in rats: a possible element in the pathophysiology of radicular syndromes. Neuro-Orthopedics. 1989; 7(2):55-9. 11. Kang JD, Georgescu HI, McIntyre-Larkin L, Stefanovic-Racic M, Donaldson WF 3rd, Evans CH. Herniated lumbar intervertebral discs spontaneously produce matrix metalloproteinases, nitric oxide, interleukin-6, and prostaglandin E2. Spine (Phila Pa 1976). 1996; 21(3): 271-7. 12. Weinstein JN, Lurie JD, Tosteson TD, Skinner JS, Hanscom B, Tosteson AN, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA. 2006; 296(20):2451-9. 13. Kisacik B, Tufan A, Kalyoncu U, Karadag O, Akdogan A, Ozturk MA, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine. 2008; 75(3): 291-4. 14. Clarke K, Sagunarthy R, Kansal S. RDW as an additional marker in inflammatory bowel Disease/Undifferentiated colitis. Digest Dis Sci. 2008; 53(9): 2521-3. 15. Cavanaugh JM. Neural mechanisms of lumbar pain. Spine (Phila Pa 1976). 1995; 20(16): 1804-9. 16. Woolf CJ, Chong MS. Preemptive analgesia-treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993; 77(2): 362-79. 17. Miyamoto H, Doita M, Nishida K, Yamamoto T, Sumi M, Kurosaka M. Effects of cyclic mechanical stress on the production of inflammatory agents by nucleus pulposus and anulus fibrosus derived cells in vitro. Spine (Phila Pa 1976). 2006; 31(1): 4-9. 18. Piperno M, Hellio le Graverand MP, Reboul P, Mathieu P, Tron AM, Perrin G, et al. Phospholipase A2 activity in herniated lumbar discs. Clinical correlations and inhibition by piroxicam. Spine (Phila Pa 1976). 1997; 22(18): 2061-5. 19. Franson RC, Saal JS, Saal JA. Human disc phospholipase A2 is inflammatory. Spine (Phila Pa 1976). 1992; 17(6): 129-32. 20. Cooper RG, Freemont AJ, Hoyland JA, Jenkins JP, West CG, Illingworth KJ, et al. Herniated intervertebral disc-associated periradicular fibrosis and vascular abnormalities occur without inflammatory cell infiltration. Spine (Phila Pa 1976) 1995; 20(5): 591-8. 21. Kawaguchi S, Yamashita T, Yokogushi K, Murakami T, Ohwada O, Sato N. Immunophenotypic analysis of the inflammatory infiltrates in herniated intervertebral discs. Spine (Phila Pa 1976). 2001; 26(11):1209-14. 22. Dagistan Y, Cukur S, Dagistan E, Gezici AR. Importance of IL-6, MMP-1, IGF-1, and BAX Levels in Lumbar Herniated Disks and Posterior Longitudinal Ligament in Patients with Sciatic Pain. World Neurosurg. 2015; 84(6): 1739-46. 23. Olmarker K, Larsson K. Tumor necrosis factor alpha and nucleus-pulposus-induced nerve root injury. Spine (Phila Pa 1976). 1998; 23(23): 2538-44. 24. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean Platelet Volume: A Link Between Thrombosis and Inflammation? Curr Pharm Design. 2011; 17(1): 47-58. 25. Gasparyan AY, Stavropoulos-Kalinoglou A, Toms TE, Douglas KM, Kitas GD. Association of mean platelet volume with hypertension in rheumatoid arthritis. Inflamm Allergy Drug Targets. 2010; 9(1): 45-50. 26. Harrison P, Cramer EM. Platelet alpha-granules. Blood Rev 1993; 7(1): 52-62. 27. Cakal B, Akoz AG, Ustundag Y, Yalinkilic M, Ulker A, Ankarali H. Red cell distribution width for assessment of activity of inflammatory bowel disease. Dig Dis Sci. 2009; 54(4): 842-7. 28. Perlstein TS, Weuve J, Pfeffer MA, Beckman JA. Red Blood Cell Distribution Width and Mortality Risk in a Community-Based Prospective Cohort. Arch Intern Med. 2009; 169(6): 588-94.
Abstract
Aim: Inflammatory
mechanisms play a key role in the pathogenesis of back pain related to disc
hernia. Novel and promising inflammatory markers in routine hemogram tests are
mean platelet volume (MPV) and red cell distribution width (RDW). We aimed to
compare the MPV and RDW values of lumbar disc herniation (LDH) patients with
healthy subjects and the symptomatic patients with sciatalgia but without
radiological evidence of lumbar disc herniation.
Materials
and Methods: This retrospective cohort study was carried out in the
department of neurosurgery of Abant Izzet Baysal University Education and
Research Hospital. We designed three groups including control (n=57), LDH
(n=73) and sciatalgia (n=20). Hemogram parameters containing white blood cell
count (WBC), hemoglobin (Hb), hematocrit (Htc), mean corpuscular volume (MCV),
RDW, platelet count (PLT), and MPV of the subjects of control, LDH and sciatalgia groups were
evaluated.
Results: Mean MPV
of the LDH, sciatalgia and control groups were 9.3 ± 1.8 fL, 8.2 ±1.1fL and 8.4
±1.0fL, respectively. Mean MPV values of LDH
group were significantly higher than sciatalgia and control groups(p=0.001).
Mean RDW values of the LDH,
sciatalgia and control groups were 14.8 ± 1.8, 13.8 ±1.0 and 13.7 ±1.2,
respectively. Mean RDW values of LDH group were also
significantly higher than sciatalgia and control groups (p=0.001).
Discussion
and Conclusion: We think that elevated MPV and RDW should be strong
indicators of LDH in patients with sciatalgia and they should be considered
prior to imaging studies. However, more prospective studies supporting our
results are needed.
References
- 1. Walker BF. The prevalence of low back pain: a systematic review of the literature from 1966 to 1998. J Spinal Disord. 2000; 13(3): 205-17. 2. Demirdağ F, Ediz L, Özgür A, Tekeoğlu İ. Kronik Lomber Disk Hernili Hastaların Tedavisinde Tens İle Elektroakupunktur Tedavisinin Karşılaştırılması. Van Tıp Dergisi. 2011; 18(1): 15-9. 3. Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012; 64(6): 2028-37. 4. Beyaz SG. Comparison of transforaminal and interlaminar epidural steroid injections for the treatment of chronic lumbar pain. Braz J Anesthesiol. 2017; 67(1): 21-7. 5. Kılıç B. Lumbar Disc Herniation. Adv. Environ Biol. 2015; 9: 44-9. 6. Takahashi H, Suguro T, Okazima Y, Motegi M, Okada Y, Kakiuchi T. Inflammatory cytokines in the herniated disc of the lumbar spine. Spine (Phila Pa 1976). 1996; 21(2): 218-24. 7. Nygaard OP, Mellgren SI, Osterud B. The inflammatory properties of contained and noncontained lumbar disc herniation. Spine (Phila Pa 1976). 1997; 22(21): 2484-8. 8. Saal JS. The Role of Inflammation in Lumbar Pain. Spine (Phila Pa 1976). 1995; 20(16): 1821-7. 9. Goupille P, Jayson MI, Valat JP, Freemont AJ. The role of inflammation in disk herniation-associated radiculopathy. Semin Arthritis Rheum. 1998; 28(1): 60-71. 10. Wehling P, Bandara G, Evans CH. Synovial cytokines impair the function of the sciatic nerve in rats: a possible element in the pathophysiology of radicular syndromes. Neuro-Orthopedics. 1989; 7(2):55-9. 11. Kang JD, Georgescu HI, McIntyre-Larkin L, Stefanovic-Racic M, Donaldson WF 3rd, Evans CH. Herniated lumbar intervertebral discs spontaneously produce matrix metalloproteinases, nitric oxide, interleukin-6, and prostaglandin E2. Spine (Phila Pa 1976). 1996; 21(3): 271-7. 12. Weinstein JN, Lurie JD, Tosteson TD, Skinner JS, Hanscom B, Tosteson AN, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA. 2006; 296(20):2451-9. 13. Kisacik B, Tufan A, Kalyoncu U, Karadag O, Akdogan A, Ozturk MA, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine. 2008; 75(3): 291-4. 14. Clarke K, Sagunarthy R, Kansal S. RDW as an additional marker in inflammatory bowel Disease/Undifferentiated colitis. Digest Dis Sci. 2008; 53(9): 2521-3. 15. Cavanaugh JM. Neural mechanisms of lumbar pain. Spine (Phila Pa 1976). 1995; 20(16): 1804-9. 16. Woolf CJ, Chong MS. Preemptive analgesia-treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993; 77(2): 362-79. 17. Miyamoto H, Doita M, Nishida K, Yamamoto T, Sumi M, Kurosaka M. Effects of cyclic mechanical stress on the production of inflammatory agents by nucleus pulposus and anulus fibrosus derived cells in vitro. Spine (Phila Pa 1976). 2006; 31(1): 4-9. 18. Piperno M, Hellio le Graverand MP, Reboul P, Mathieu P, Tron AM, Perrin G, et al. Phospholipase A2 activity in herniated lumbar discs. Clinical correlations and inhibition by piroxicam. Spine (Phila Pa 1976). 1997; 22(18): 2061-5. 19. Franson RC, Saal JS, Saal JA. Human disc phospholipase A2 is inflammatory. Spine (Phila Pa 1976). 1992; 17(6): 129-32. 20. Cooper RG, Freemont AJ, Hoyland JA, Jenkins JP, West CG, Illingworth KJ, et al. Herniated intervertebral disc-associated periradicular fibrosis and vascular abnormalities occur without inflammatory cell infiltration. Spine (Phila Pa 1976) 1995; 20(5): 591-8. 21. Kawaguchi S, Yamashita T, Yokogushi K, Murakami T, Ohwada O, Sato N. Immunophenotypic analysis of the inflammatory infiltrates in herniated intervertebral discs. Spine (Phila Pa 1976). 2001; 26(11):1209-14. 22. Dagistan Y, Cukur S, Dagistan E, Gezici AR. Importance of IL-6, MMP-1, IGF-1, and BAX Levels in Lumbar Herniated Disks and Posterior Longitudinal Ligament in Patients with Sciatic Pain. World Neurosurg. 2015; 84(6): 1739-46. 23. Olmarker K, Larsson K. Tumor necrosis factor alpha and nucleus-pulposus-induced nerve root injury. Spine (Phila Pa 1976). 1998; 23(23): 2538-44. 24. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean Platelet Volume: A Link Between Thrombosis and Inflammation? Curr Pharm Design. 2011; 17(1): 47-58. 25. Gasparyan AY, Stavropoulos-Kalinoglou A, Toms TE, Douglas KM, Kitas GD. Association of mean platelet volume with hypertension in rheumatoid arthritis. Inflamm Allergy Drug Targets. 2010; 9(1): 45-50. 26. Harrison P, Cramer EM. Platelet alpha-granules. Blood Rev 1993; 7(1): 52-62. 27. Cakal B, Akoz AG, Ustundag Y, Yalinkilic M, Ulker A, Ankarali H. Red cell distribution width for assessment of activity of inflammatory bowel disease. Dig Dis Sci. 2009; 54(4): 842-7. 28. Perlstein TS, Weuve J, Pfeffer MA, Beckman JA. Red Blood Cell Distribution Width and Mortality Risk in a Community-Based Prospective Cohort. Arch Intern Med. 2009; 169(6): 588-94.
Details
| Subjects | Health Care Administration |
|---|---|
| Journal Section | ORIGINAL ARTICLE |
| Authors | |
| Publication Date | January 29, 2018 |
| Acceptance Date | December 21, 2017 |
| Published in Issue | Year 2018 Volume: 23 Issue: 1 |
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