Single Intradiscal Administration of the Tumor Necrosis Factor-Alpha Inhibitor, Etanercept, for Patients with Discogenic Low Back Pain
Single Intradiscal Administration of the Tumor Necrosis Factor-Alpha Inhibitor, Etanercept, for Patients with Discogenic Low Back Pain
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DOI：
10.1111/pme.12892
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发表时间：
2016-01-01
期刊：
影响因子：
3.1
通讯作者：
Ohtori, Seiji
中科院分区：
文献类型：
--
作者：
Sainoh, Takeshi;Orita, Sumihisa;Ohtori, Seiji
目标。目的探讨椎间盘源性腰痛（LBP）患者椎间盘内给予肿瘤坏死因子-aa （TNF-a）抑制剂的镇痛效果。前瞻性、随机研究。日本千叶大学附属医院骨科。诊断为椎间盘源性lbp的患者77例。椎间盘源性LBP患者随机分为依那西普组（n = 38；布比卡因组[2 mL]，依那西普组[10 mg]）和对照组（n = 39；布比卡因组[2 mL]）。患者接受单次椎间盘内注射。记录注射后基线、1天、1、2、4、8周LBP数值评定量表（NRS）评分。在基线和注射后4周和8周评估Oswestry残疾指数（ODI）评分。记录并评价注射后并发症。注射后8周，依那西普组各时间点NRS评分均显著低于对照组（P < 0.05）。同样，注射后4周，依那西普组ODI评分低于对照组（P < 0.05）。然而，ODI评分在8周时无显著差异。无并发症发生。单次椎间盘内给药tnf - α抑制剂可缓解顽固性椎间盘源性腰痛长达8周。tnf - α可能参与椎间盘源性疼痛的发病机制。这种方法是一种新的潜在治疗方法；今后需要进行更长期的有效性试验。
Objective. To examine the analgesic effect of intradiscal administration of a tumor necrosis factor-aa (TNF-a) inhibitor in patients with discogenic low back pain (LBP).Design. Prospective, randomized study.Setting. Department of Orthopaedic Surgery, Chiba (Japan) University Hospital.Subjects. Seventy-seven patients diagnosed with discogenic LBP.Methods. Discogenic LBP patients were randomly assigned to the etanercept (n = 38; bupivacaine [2 mL] with etanercept [10 mg]) or control (n = 39; bupivacaine [2 mL]) groups. Patients received a single intradiscal injection. Numerical rating scale (NRS) scores for LBP at baseline, 1 day, and 1, 2, 4, and 8 weeks after the injection were recorded. The Oswestry disability index (ODI) scores at baseline and at 4 and 8 weeks after injection were evaluated. Postinjection complications were recorded and evaluated.Results. In the etanercept group, the NRS scores were significantly lower than in the control group at every time point after the injection for 8 weeks (P < 0.05). Similarly, 4 weeks after the injection, the ODI score was lower in the etanercept group than in the control group (P < 0.05). However, the ODI scores were not significantly different at 8 weeks. Complications were not observed.Conclusions. Single intradiscal administration of a TNF-alpha inhibitor can alleviate intractable discogenic LBP for up to 8 weeks. TNF-alpha may be involved in discogenic pain pathogenesis. This procedure is a novel potential treatment; longer-term effectiveness trials are required in the future.