Serap Satis, Alparslan Yetisgin, Kadri Burak Ethemoglu

Can inflammation parameters be determinant in upperlevel lumbar disc hernias?

Aim: Upper lumbar disc hernias are disc hernias located at the L1–L2, L2–L3, and L3–L4 levels. Upper lumbar disc hernias make up approximately 5% of herniated lumbar discs. The etiology of upper lumbar disc hernias is unclear. We investigated the relationship between hemogram values, sedimentation, C-reactive protein values and upper lumbar disc hernias.Materials and Methods: Patients were divided into three groups: Group 1 (61 patients with upper lumbar disc hernias), Group 2 (96 patients with lower level lumbar disc hernias), and Group 3 (40 patients without disc hernias). Gender, age, serum hemogram parameters, including white blood cell, lymphocyte, neutrophil, monocyte, mean platelets volume, plateletss, red cell distribution width, neutrophil-to-lymphocyte ratio, platelets-to-lymphocyte ratio, sedimentation and C-reactive protein values were obtained from the system and recorded. Patients; Acute pain ( 3 months) was evaluated.Results: The group with upper lumbar disc hernias (Group 1) had the highest mean age; there were also statistically significant differences between Group 1 and Group 2 and between Group 2 and Group 3 in terms of age (p < 0.05 and p = 0.021, respectively). There were no significant differences between groups in terms of gender, hemogram parameters, sedimentation and C-reactive protein values, neutrophil-to-lymphocyte ratio or platelets-to-lymphocyte ratio. Groups were also evaluated for acute, subacute and chronic pain, and there were no significant differences between groups.Conclusion: We concluded that hemogram parameters (white blood cell count, lymphocyte count, neutrophil count, monocytes, red cell distribution width, mean platelets volume and platelets count), sedimentation and C-reactive protein values, neutrophil-tolymphocyte ratio and platelets-to-lymphocyte ratio are not indicators for diagnosis of upper lumbar disc hernias.

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1. Kang JD, Stefanovic-Racic M, McIntyre LA, et al. Toward a biochemical understanding of human intervertebral disc degeneration and herniation. Contributions of nitric oxide, interleukins, prostaglandin E2, and matrix metalloproteinases. Spine (Phila Pa 1976)1997;22:1065-73.
2. Colonno DV, Harrast MA, Herring SA. Overview of spinal interventions. Clin Sports Med 2012;31:409-22.
3. Albert TJ, Balderston RA, Heller JG, et al. Upper lumbar disc herniations. J Spinal Disord 1993;6:351-9.
4. Nadler SF, Campagnolo DI, Tomaio AC, et al. High lumbar disc: Diagnostic and treatment dilemma. Am J Physical Medicine & Rehabilitation 1998;77:538-44.
5. Bosacco SJ, Berman AT, Raisis LW, et al. High lumbar disc herniation. Orthopedics 1989;12:275-8.
6. Hsu K, Zucherman J, Shea W, et al. High lumbar disc degeneration: incidence and etiology. Spine 1990;15:679-82.
7. Casey E. Natural history of radiculopathy. Phys Med Rehabil Clin N Am 2011;22: 1-5.
8. Tian P, Ma XL, Wang T, et al. Correlation between radiculalgia and counts of T lymphocyte subsets in the peripheral blood of patients with lumbar disc herniation. Orthop Surg 2009;1:317-21.
9. Kawakami M, Tamaki T, Matsumoto T, et al. Role of leukocytes in radicular pain secondary to herniated nucleus pulposus. Clin Orthop Relat Res 2000;376:268-77.
10. Polat Ö, Tuncer C. Tek Seviye Lomber Disk Hernisi ve Çok Seviyeli Lomber Spinal Stenoz Hastalarında Sistemik İnflamasyon Varlığının Araştırılması. Konuralp Tıp Dergisi 2019;11:247-52.
11. Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis 2014;73:968-74.
12. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol 2015;36:811-6.
13. Dammers R. JKoehler P. Lumbar disc herniation: level increases with age, Surgical Neurology 2002;58:209- 12.
14. Yuce I, Kahyaoglu O, Mertan P, et al. Analysis of clinical characteristics and surgical results of upper lumbar disc herniations. Neurochirurgie 2019;65:158-63.
15. Lurie JD, Faucett SC, Hanscom B, et al. Lumbar discectomy outcomes vary by herniation level in the Spine Patient Outcomes Research Trial. J Bone Joint Surg Am 2008;90:1811-9.
16. Park CH, Lee SH. Investigation of High-Sensitivity C-reactive Protein and Erythrocyte Sedimentation Rate in Low Back Pain Patients. Korean J Pain 2010; 23:147-50.
17. Bozkurt H, Arac D, Cigdem B. Effect of Preoperative Uric Acid Level and Neutrophil / Lymphocyte Ratio on Preoperative and Postoperative Visual Analogue Pain Scores in Patients with Lumbar Disc Herniation: A Cross-Sectional Study. Turk Neurosurg 2019;29:705- 9.
18. Dagistan Y , Dagistan E , Gezici AR , et al. Could red cell distribution width and mean platelet volume be a predictor for lumbar disc hernias? Ideggyogy Sz 2016;69:411-4.
19. Chandrashekara S, Mukhtar Ahmad M, Renuka P, et al. Characterization of neutrophil-to-lymphocyte ratio as a measure of inflammation in rheumatoid arthritis. Int J Rheum Dis 2017;20:1457-67.
20. Akturk S, Buyukavcı R. Evaluation of blood neutrophillymphocyte ratio and platelet distribution width as inflammatory markers in patients with fibromyalgia. Clinical Rheumatology 2017;36:1885-9.
21. Saal JS. The role of inflammation in lumbar pain. Spine (Phila Pa 1976) 1995; 20:1821-7.
22. Franson RC, Saal JS, Saal JA. Human disc phospholipase A2 is inflammatory. Spine (Phila Pa 1976) 1992;17:129-32.
23. Djuric N, Lafeber GCM, Vleggeert-Lankamp CLA. The contradictory effect of macrophage-related cytokine expression in lumbar disc herniations: a systematic review [published online ahead of print, 2019 Nov 25]. Eur Spine J 2019;10.1007/s00586-019-06220.
24. Sadowska A, Touli E, Hitzl W, et al. Inflammaging in cervical and lumbar degenerated intervertebral discs: analysis of proinflammatory cytokine and TRP channel expression. Eur Spine J 2018; 27:564-77.
25. Djuric N, Yang X, El Barzouhi A, et al. Lumbar disc extrusions reduce faster than bulging discs due to an active role of macrophages in sciatica. Acta Neurochir (Wien) 2020;162:79-85.
26. Weber KT, Alipui DO, Sison CP, et al. Serum levels of the proinflammatory cytokine interleukin-6 vary based on diagnoses in individuals with lumbar intervertebral disc diseases. Arthritis Res Ther 2016;18:3. Published 2016 Jan 7.
27. Karabag H, Yetisgin A, Savik E, et al. Evaluation of ceruloplasmin levels in patients with lumbar disc herniation. Journal of back and musculoskeletal rehabilitation 2017;30:45-9.
28. Elkan P , Sten-Linder M, Hedlund R, et al. Markers of inflammation and fibrinolysis in relation to outcome after surgery for lumbar disc herniation. A prospective study on 177 patients. Eur Spine J 2016;25:186-91.
29. Hsu K, Zucherman J, Shea W, et al. High lumbar disc degeneration. Incidence and etiology. Spine (Phila Pa 1976) 1990;15: 679-82.
30. Tokuhashi Y, Matsuzaki H, Uematsu Y, et al. Symptoms of thoracolumbar junction disc herniation. Spine (Phila Pa 1976) 2001;26:512-8.
31. de Schepper EI, Damen J, Bos PK, et al. Disk degeneration of the upper lumbar disks is associated with hip pain. Eur Spine J 2013;22(4):721-6.
32. Kido T, Okuyama K, Chiba M, et al. Clinical diagnosis of upper lumbar disc herniation: Pain and/or numbness distribution are more useful for appropriate level diagnosis. J Orthop Sci 2016;21:419-24.
33. Wei CP, Cheng WC, Lee ST, et al. Upper lumbar disc herniation. Chang Keng I Hsueh 1989;12:193-9.
34. Spangfort EV. The lumbar disc herniation. A computeraided analysis of 2,504 operations. Acta Orthop Scand [Suppl] 1972;142:1-95