The impact of preoperative symptom duration and histological changes in the nucleus pulposus on the postoperative clinical outcomes of MIS-TLIF in patients with lumbar degenerative diseases
10.3969/j.issn.1671-8348.2025.05.031
- VernacularTitle:术前症状持续时间及髓核组织学改变对腰椎退行性疾病患者MIS-TLIF术后临床结局的影响
- Author:
Liangliang YAN
1
;
Weijuan YU
Author Information
1. 南京市浦口区中医院骨伤科,南京 211800
- Keywords:
preoperative symptom duration;
nucleus pulposus;
minimally invasive transforaminal lum-bar interbody fusion;
efficacy evaluation;
inflammatory factors
- From:
Chongqing Medicine
2025;54(5):1218-1224
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the effects of preoperative symptom duration(DOS)and histolog-ical changes in the nucleus pulposus on the outcome of minimally invasive transforaminal lumbar interbody fu-sion(MIS-TLIF)in patients with lumbar degenerative diseases.Methods A total of 162 patients in this hos-pital with lumbar degenerative diseases who underwent MIS-TLIF surgery from March 2022 to June 2023 were prospectively enrolled.According to DOS,they were divided into the short-term DOS group(group S,DOS＜12 months)and the long-term DOS group(group L,DOS ≥ 12 months).Nucleus pulposus tissue was collected for hematoxylin-eosin(HE)staining to observe tissue morphology,immunohistochemical staining was used to detect protein expression of interleukin(IL)-6,IL-1,and tumor necrosis factor-α(TNF-α),and re-al-time fluorescence quantitative PCR(qPCR)was used to analyze the expression levels of IL-6 mRNA,IL-1 mRNA,and TNF-α mRNA.The Oswestry Disability Index(ODI)score and Visual Analog Scale(VAS)score for lower back pain,leg pain,and numbness before surgery and at 1,3,6,12 months after surgery were com-pared to evaluate clinical efficacy.Results There was no significant difference in baseline data between Group S and Group L(P＞0.05).HE staining showed that the degeneration,cracking,and inflammatory infiltration of the nucleus pulposus in group L were more pronounced than those in group S;The results of immunohisto-chemistry and qPCR showed that the protein expressions of IL-6,IL-1,and TNF-α in group L were more obvi-ously and their mRNA expression levels were significantly higher than those in group S(P＜0.05).Both groups showed a significant decrease in postoperative ODI,VAS score for lower back pain,VAS score for leg pain,and VAS score for numbness compared to preoperative levels(P＜0.05).However,three months after surgery,the ODI,VAS score for lower back pain and numbness in group S were lower than those in group L(P＜0.01);Six months after surgery,the VAS score for back pain,leg pain,and numbness in group S were lower than those in group L(P＜0.01);12 months after surgery,the VAS score for numbness in group S was still lower than that in group L(P＜0.01).Subgroup analysis of patients with cauda equina syndrome showed that at 3 months after surgery,the VAS score for lower back pain in group S were lower than that in group L(P＜0.01);six months after surgery,the VAS score for leg pain in group S was lower than that in group L(P＜0.01);12 months after surgery,the VAS score for back pain,leg pain,and numbness in group S were lower than those in group L(P＜0.01).Conclusion Long-term DOS is significantly associated with high ex-pression of inflammatory factors in the nucleus pulposus and delayed long-term functional recovery.Early sur-gical intervention can optimize the clinical outcomes of patients with lumbar degenerative diseases.
