gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Proinflammatory cytokines as a predictor for the postoperative outcome in minimally invasive lumbar spine procedures

Meeting Abstract

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  • Patrick Fröhner - Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
  • Mario Leimert - Hohwald , Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocP 080

doi: 10.3205/17dgnc643, urn:nbn:de:0183-17dgnc6439

Published: June 9, 2017

© 2017 Fröhner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

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Objective: Even in spine centres with a high level of procedural and surgical skills, the percentage of an unsuccessful outcome with remaining back pain after lumbar disc operations lies at 25.4%, 12.7% reported severe back pain. (Yorimitsu, 2001). Also, there is reported to be no significant difference in outcome between macro discectomy and micro discectomy (Katayama, 2006). It seems reasonable to apply paraclinical parameters that are independent of the surgeon and to analyse their impact. Goal of this project is to identify moderating variables for the processing of the outcome of this kind of surgery. The local release of pro- and anti-inflammatory cytokines, which can affect systemic body reactions and thus adversely affect the clinical course, might have an important role. In addition to others, TNFα and Interleukin 6 were described as key pro-inflammatory cytokines for the post-operative course.

Methods: From March 2012 to July 2014 32 patients (20 m, 12 f) with an average age of 61 years (SD 17.01) were treated via microscopically supported interlaminar fenestration and discectomy in the department of Neurosurgery, University Hospital Carl Gustav Carus Dresden. Included were patients with a herniated disc in the segments L3-L5. The control group was formed via matched pairs by healthy individuals. One day before the operation, a survey of ACTH, Cortisol, TNFα, and Interleukin 6 was taken during the stress response of the Trier Social Stress Test. This is a method under which a significant measurable humoral stress response of the relevant hormones and cytokines can be achieved. At the same time, a survey of relevant questionnaires (numerical analogue scale, McGill Pain Questionnaire) was conducted by means of which the postoperative symptom experience was made operational and comparable to the evaluation of the same information thirty days afterwards.

Results: The TNFα- and Interleukin 6-Baselines before the stress test were elevated by 26.2% and 91.2% compared to the control group. Furthermore, the whole stress response in patients, showed in an area under the curve, was significantly higher by 18.7% and 89.6%. In fact, patients with higher area under the curve were more likely to report less benefit and more postoperative pain (p < 0.05). All of these results appear to be independent by affecting variables such as the patient`s medication and the preoperative duration of pain.

Conclusion: Recapitulatory, including a survey of cytokine reaction and baselines proofed to be a significant tool in forecasting subjective pain reduction in chronic back pain patients undergoing lumbar disc surgery. This might prove to be just as helpful in clinical settings by increasing the success rate for both the surgeon and the patient. A long term outcome analysis is being prepared.