OBJECTIVE: The purpose of this study is to find out what is the effect of epidural corticosteroid injection on bone metabolism. METHOD: We have assessed the systemic effects of a single epidural triamcinolone acetonide injection on biochemical indices of bone formation and resorption in patients with lumbosacral radiculopathy. Twenty patients who had lumbosacral radiculopathy and free from exposure to corticosteroid for at least 6 weeks were selected for this study. Patients were classifed as two groups; 1) epidural block with 2% lidocaine 3 ml and 0.9% normal saline 15 ml (4 men, 5 women; mean age 47.2+/-7.6 years) and 2) combination of triamcinolone acetonide 40 mg (5 men, 6 women; mean age 49.6+/-8.2 years). Fasting serum and the second voided urine were collected at 0, 1, 3, 7 and 14 days after the single epidural injection for bone-related biochemicalmarkers measurements. RESULTS: 1) Level of serum osteocalcin showed a significant time trend in the epidural corticosteroid injection group. Osteocalcin decreased dramatically from 11.2+/-3.4 ng/ml on day 0 to 5.9+/-2.8 ng/ml on day 1, 6.1+/-1.5 ng/ml on day 3 (p<0.05). After the initial drop, the level recovered to 9.8+/-3.7 ng/ml by day 7, and returned to preinjection level on day 14, at 10.9+/-4.1. 2) Urinary deoxypyridinoline levels did not show any significant changes. CONCLUSION: According to the above results, the epidural injection of corticosteroid may be a better therapeutic mode, with less potential for harmful effects to bone metabolism, in providing effective relief of symptoms to patients with lumbosacral radiculopaties.
Fasting ; Female ; Humans ; Injections, Epidural ; Lidocaine ; Male ; Metabolism* ; Osteocalcin ; Osteogenesis ; Radiculopathy ; Triamcinolone Acetonide

OBJECTIVESTo investigate the significance of c-fos oncogene morphogenetic protein's locational expression, and the correlativity between nerve transmitters calcitonin gene-related peptide (CGRP) expression and nerve root's functional change using the animal model of the chronic compressive injury in the nerve root.

METHODSThe animal model of chronic compressive injury of the nerve root was established by transplanting autogenous cancellous bone into the intervertebral foramen. During different injury phase (1, 2, 4, 8, 12, 24 weeks after operation), the functional status of the nerve root was determined under the monitoring of evoked potential, and the expression changes of c-fos oncogene morphogenetic protein and nerve transmitter CGRP were detected using in situ hybridization technique and their expression intensity was determined using automatic image analytic instrument respectively.

RESULTSOne week after operation, the c-fos expression strengthened in both anterior and posterior root fiber obviously. Two to four weeks after operation, the expression of the posterior root fiber weakened than the anterior root fiber. After 12 weeks, the anterior root fiber expression turned down obviously, however the posterior root fiber expression backed up slightly compared with that of the 8 weeks. By the time of 24 weeks after operation, the expression enhancement in all roots disappeared. CGRP expression increased obviously at the site of compressive axon of both anterior and posterior root. The expression of the posterior root axon and ganglion cell was higher than that of the anterior root axon. CGRP expression was diminished in the second week than the first week, and that was especially obvious in the posterior root and ganglion cell. But 4 weeks after operation, the expression enhanced once more, and that was more obvious inside the anterior root axon. Eight weeks after operation, the expression intensity attained the high peak. Twelve weeks after operation, the expression started the slow-moving descent.

CONCLUSIONSThe expression of c-fos gene protein is beneficial to localize the damaged part of certain nerve. During chronic injury, the degeneration of posterior root sensory fiber is earlier than the anterior root motor fiber. The expression of CGRP strengthened when the nerve fiber degenerated by the harmful stimulation, and the expression intensity is positively related with pain. That suggests when the nervous tissue is hurt, the information of warning and regulation should be sent out to our body.

Animals ; Calcitonin Gene-Related Peptide ; metabolism ; Cats ; Disease Models, Animal ; Female ; In Situ Hybridization ; Male ; Proto-Oncogene Proteins c-fos ; metabolism ; Radiculopathy ; metabolism ; physiopathology ; Spinal Nerve Roots ; physiopathology

Although sympathetic blockade is clinically used to treat pain, the underlying mechanisms remain unclear. We developed a localized microsympathectomy (mSYMPX), by cutting the grey rami entering the spinal nerves near the rodent lumbar dorsal root ganglia (DRG). In a chemotherapy-induced peripheral neuropathy model, mSYMPX attenuated pain behaviors via DRG macrophages and the anti-inflammatory actions of transforming growth factor-β (TGF-β) and its receptor TGF-βR1. Here, we examined the role of TGF-β in sympathetic-mediated radiculopathy produced by local inflammation of the DRG (LID). Mice showed mechanical hypersensitivity and transcriptional and protein upregulation of TGF-β1 and TGF-βR1 three days after LID. Microsympathectomy prevented mechanical hypersensitivity and further upregulated Tgfb1 and Tgfbr1. Intrathecal delivery of TGF-β1 rapidly relieved the LID-induced mechanical hypersensitivity, and TGF-βR1 antagonists rapidly unmasked the mechanical hypersensitivity after LID+mSYMPX. In situ hybridization showed that Tgfb1 was largely expressed in DRG macrophages, and Tgfbr1 in neurons. We suggest that TGF-β signaling is a general underlying mechanism of local sympathetic blockade.
Mice ; Animals ; Receptor, Transforming Growth Factor-beta Type I/metabolism* ; Transforming Growth Factor beta/pharmacology* ; Transforming Growth Factor beta1/metabolism* ; Hyperalgesia/metabolism* ; Radiculopathy/metabolism* ; Pain/metabolism* ; Analgesics/pharmacology* ; Ganglia, Spinal/metabolism*

In order to investigate the role of spinal glutamate transporter 1 (GLT-1) in the neuropathic pain and morphine tolerance, rat chronic constriction injury (CCI) of sciatic nerve was performed, and the mechanical allodynia was evaluated by mechanical withdrawal threshold (MWT), the expression of GLT-1 was measured by real-time PCR and Western blotting analysis. The results showed that compared to sham group, the MWT of CCI group had decreased approximately 80%. Administration of morphine alone could develop tolerance rapidly in initial two days, and then had no significant difference with CCI group, the expression of GLT-1 was down-regulated. Ceftriaxone sodium alone could improve mechanical allodynia. Co-administration of ceftriaxone sodium with morphine attenuated morphine tolerance and up-regulated GLT-1 expression, and the MWT remained at high level after 6 days. In conclusion, change of spinal GLT-1 expression and function has close correlation with the development of neuropathic pain and morphine tolerance.
Animals ; Drug Tolerance ; Excitatory Amino Acid Transporter 2 ; metabolism ; pharmacology ; Female ; Male ; Morphine ; pharmacology ; Radiculopathy ; metabolism ; pathology ; Rats ; Rats, Wistar ; Sciatic Nerve ; pathology ; Sciatic Neuropathy ; metabolism ; pathology ; Spinal Cord ; drug effects ; metabolism

The aim of this study was to investigate the effect of platelet-rich plasma (PRP) on cavernous nerve (CN) regeneration and functional status in a nerve-crush rat model. Twenty-four Sprague-Dawley male rats were randomly divided into three equal groups: eight had a sham operation, eight underwent bilateral nerve crushing with no further intervention and eight underwent bilateral nerve crushing with an immediate application of PRP on the site of injury. Erectile function was assessed by CN electrostimulation at 3 months and nerve regeneration was assessed by toluidine blue staining of CN and nicotinamide adenine dinucleotide phosphate (NADPH)-diaphorase staining of penile tissue. Three months after surgery, in the group that underwent bilateral nerve crushing with no further intervention, the functional evaluation showed a lower mean maximal intracavernous pressure (ICP) and maximal ICP per mean arterial pressure (MAP) with CN stimulation than those in the sham group. In the group with an immediate application of PRP, the mean maximal ICP and maximal ICP/MAP were significantly higher than those in the injured control group. Histologically, the group with the application of PRP had more myelinated axons of CNs and more NADPH-diaphorase-positive nerve fibres than the injured control group but fewer than the sham group. These results show that the application of PRP to the site of CN-crush injury facilitates nerve regeneration and recovery of erectile function. Our research indicates that clinical application of PRP has potential repairing effect on CN and peripheral nerves.
Animals ; Disease Models, Animal ; Electric Stimulation ; Erectile Dysfunction ; pathology ; physiopathology ; therapy ; Male ; NADPH Dehydrogenase ; metabolism ; Nerve Regeneration ; physiology ; Penile Erection ; physiology ; Penis ; innervation ; Peripheral Nerve Injuries ; Peripheral Nerves ; metabolism ; pathology ; Platelet Transfusion ; Platelet-Rich Plasma ; Radiculopathy ; etiology ; pathology ; physiopathology ; Rats ; Rats, Sprague-Dawley