The Effect Of The Different Types Of Cortisol Secretion On The Prognosis Of Lumbar Discectomy

ObjectivesTo investigate the saliva cortisol level of the chinese patients with discogenic sciatica,and to clarify the correlation between the psychoscocial factors and the saliva cortisol level in order to identify the effect of the different types of cortisol secretion on the prognosis of lumbar discectomy.Methods37 patients with discogenic sciatica were examined before and after discectomy surgery.18 patients with chronic somatic pain from psychological outpatient service were included in this study.20 healthy pain-free subjects constitute the control group. The diurnal pattern of cortisol secretion of these three groups were assessed.The preoperative examination of the patients with discogenic sciatica included physical, radiographic and serum examination,with which to compare the postoperative improvement after a short period of follow-up.And the correlation between the cotisol secretion level and the data from psychoscocial survey preoperatively was clarified.ResultThe patients with chronic somatic pain showed significantly low level of cortisol secretion at the declining period and an obvious fall from peak(P＜0.01).The follow-up was 7.7 months at average.The improvement of JOA-score has positive correlation with peak and declining period of the cortisol secretion,while negative correlation with the fall.The correlative psychoscocial factors with the improvement of JOA-score are Duration of sick leave,work satisfaction,preoperative pain,depression,which are also interrelated to the cortisol secretion level.ConclusionThe cortisol secretion level is the correlative physiological mechanism for the effect of the psychoscocial factors on the prognosis of lumbar discectomy.And the patients with unstable type of cortisol secretion tend to fail in the result of lumbar discectomy.