Correlation Between Inflammatory Cytokines Levels In Nucleus Pulposus And Cervical Degeneration , Cervical Spondylotic Myelopathy: A Prospective Non-randomized Study

Cervical spondylotic myelopathy is a spinal cord disease that spinal cord is compressed or ischemic due to cervical disc degeneration and herniation of the nucleus pulposus, which results in dysfunction of spinal cord and affects feeling and activity of the limbs and urination and defecation as well. In the process of disc degeneration, not only are the morphological and histological changes, but also biochemical properties of the disc with a series of changes. Recent studies have revealed the biochemical mechanism of disc degeneration and its effects on nerve function, and the "network" type of interaction between cytokines has also become increasingly clear. Cytokines in the pathogenesis of disc degeneration may play an important role in regulating.Objective: In recent years, with the rapid development of molecular biology and molecular immunology and the further research on cytokines, cytokines in the cervical intervertebral disc degeneration and the role of the pathogenesis of cervical spondylotic myelopathy are paid more and more attention. The role about cytokines in the cervical intervertebral disc degeneration and the process of cervical spondylotic myelopathy has been extensive and in-depth study. Many results support the role about cytokines in the cervical intervertebral disc degeneration and the process of cervical spondylotic myelopathy[1,2]. Most research has focused on the biochemistry mechanism of lumbar disc degeneration and its influence to nerve function[3,4,5,6], but it is not certain whether the same mechanism can be adjusted to cervical intervertebral discs due to cervical pressure-bearing and activity. At present, there are few studies on the role about cytokines in in the cervical intervertebral disc degeneration and the process of cervical spondylotic myelopathy. As a prospective non-randomized study, this research aims to explore the correlation between inflammatory cytokines levels in nucleus pulposus and cervical degeneration, cervical spondylotic myelopathy as well as its relationship with the severity of associated neurological symptoms through using ELISA and RIA methods to detect quantitatively the expression levels of cytokines in cervical disc with different degeneration in order to intervene the "negative" role about cytokines in cervical intervertebral disc degeneration and the process of cervical spondylotic myelopathy, which provide a theoretical basis for comprehensive clinical treatment.Methods: Non-randomly selected from June 2010 to October 2010 in our hospital, 46 patients with cervical degeneration or cervical spondylotic myelopathy, including 24 males and 22 females, aged 45 to 70 years old, average 55.7 years old. According to cervical MRI before operation and whether the nucleus pulposus was free in operation, 46 patients were divided non-randomly into two groups: uncontained IVD herniation and contained IVD herniation. Besides, 15 normal, nondegenerated discs as control group were obtained from young cervical trauma patients who had no cervical degeneration or CSM before, including 9 males and 6 females, aged 22 to 37 years old, average 29.8 years old. All patients underwent standard anterior cervical discectomy decompression and fusion with internal fixation. Repeatedly wash the disc specimens with saline until the contaminated blood is cleaned. To avoid the degradation of cytokines, in 30min place in a refrigerator at minus 80 degrees save. After all the samples to be collected, measure together. IL-1a, MMP3 were assessed respectively using radioimmunoassay (RIA) method, and IL-6, TNF-a levels of three groups were assessed respectively using radioimmunoassay (RIA) method. According to the Japanese Orthopedic Association (JOA) scoring system, all the patients with cervical degeneration or cervical spondylotic myelopathy were divided into two groups: mild group, moderate and severe group, which were compared respectively the expression levels of TNF-a, IL-6, IL-1a, and MMP3. All of the sample patients excluded system inflammatory disease, cervical cancer, tuberculosis, multiple peripheral neuritis, deformation and so on. All operations were performed by the same group of surgeon, and all surgical specimens tested in uniform by professionals of the Central Laboratory and Radiation Laboratory of the Third Hospital of Hebei Medical University.Results:â‘ Cytokines (TNF-a,IL-6,IL-1a and MMP3) are all discovered in both uncontained and contained IVD herniation.â‘¡Cytokines expression levels in different degenerative degrees of cervical nucleus pulposus: There was significant difference among three groups for Cytokines levels of cervical nucleus pulposus (P<0.05). Moreover, cytokine levels among three groups showed a positive correlation trend in the cervical degenerative process.â‘¢Cytokines expression levels in different degrees of JOA score: There was also significant difference between mild group, moderate and severe group for Cytokines levels of cervical nucleus pulposus (P<0.05). Moreover, cytokine levels among mild group, moderate and severe group also showed a positive correlation trend in the cervical degenerative process.Conclusion:â‘ This experiment proves that the inflammatory mediators(IL-1, IL-6, TNF-a and MMP3) involved in cervical disc degeneration and cervical disease.â‘¡Cytokines expression levels show a positive correlation trend in pathological process. The higher the degeneration degree of cervical intervertebral disc, the higher the cytokines expression levels.â‘¢MMP3 and TNF-a are closely related to cervical intervertebral disc degeneration and nucleus pulposus herniation. TNF-a are closely related to spinal cord function, which may play an accelerated role in worsening nerve function.â‘£Cytokines may be one of the reasons which lead to cervical intervertebral disc degeneration.