Expression And Significance Of TNF-α,IL-1β And IL-6 In Degenerative Lumbar Scoliosis

Objective: To explore the expression of TNF-α, IL-1βand IL-6 in degener ative human intervertebral discs, the relationship between those cytokines and disc degeneration of the degenerative lumbar scoliosis, and analyze the cause of th- e disease, supply theory base in the clinical use. Degenerative lumb sco- liosis has historically been simply defined as a spinal deformity in a skeletally mature atient with a Cobb angle of more than 10°in the coronal plain, which develops after skeletal maturity with a predominant lumbar location. However, recently, through a better understanding of biomechanics, spinal anatomy, and imaging techniques, it has been recognized that, in addition to the coronal im- balance, there is also an associated loss of sagittal balance and malrotation of the spine, which are integral components of the deformity. Degenerative lum- bar scoliosis, therefore, represents a complex three-dimensional rotational def- ormity that affects the spine in the coronal, sagittal, and axial planes and thus treatment paradigms should be devised to address all three components of this disorder. With the well documented age shift of our population, degenerative lumbar scoliosis is becoming increasingly prevalent, and seriously affects the life quality of the elderly. The degenerative lumbar scoliosis has no categorica separate criteria. The cause of degenerative lumbar scoliosis is unclear.The in- itiating agent of the degenerative lumbar scoliosis is a symmetric degeneration of the disc and/or the facet joints. Degenerative scoliosis, specifically in the l- umbar spine, is characterized by quite a uniform pathomorphology and patho- mechanism. The asymmetric degeneration of the disc and/or the facet joints l- eads to an asymmetric loading of the spinal segment and consequently of a w- hole spinal area. This again leads to an asymmetric deformity, for example, sc- oliosis and/orkyphosis. Such a deformity again triggers asymmetric degenerat- ion and induces asymmetric loading, creatin g a vicious circle and enhancing curve progression. On the one hand, the curve progression is given by the pat- homechanism of an adult degenerative curve, and on the other hand by the sp- ecific bone metabolism of the post-menopause female patients with a certain degree of osteoporosis, who are most frequently affected by the degenerative form of scoliosis. The potential of individual asymmetric deformation and col- lapse in the weak osteoporotic vertebra is clearly increased and contributes fu- rther to the curve progression. The osteophytes of the facet joints and the spo- ndylotic osteophytes, however, may not sufficiently stabilize a diseased spinal segment; such a condition leads to a dynamic, mostly foraminal stenosis with radicular pain or claudication type pain.The changing of the moity of the endplat, nucleus pulposus and anulus fibrosus is the grounding of degenerative of the ntervertebral disc, which induces the biology function down. However, the process of disc degeneration is unclear. A lot of scholars explore the degenerative mechanism at the molecule and the gene. The recent results showed close relationship between TNF-α, IL-1βand IL-6 and the intervertebral discs degeneration. These cytokines have an effect on mediating the inflammatory reactions. The expression of TNF-α, IL-1βand IL-6 in cervical spondylotic and lumbar intervertebral disc is definite, but is unclear in the degenerative lumbar scoliosis.Methods: From March 2008 to October 2009, a total of 53 cases were enrolled in the department of spine surgery of the third hospital of He Bei Medical University. In the test group, 36 specimens of lumbar intervertebral disc tissue were surgically obtained from 34 patients who suffered from degenerative lumbar scoliosis. Each included end plate, fibrosus annulus and nucleus. And in the control group, 17 specimens of intervertebral disc tissue were obtained from 17 adolescent idiopathic scoliosis patients with no disc degenerationn who were strong and healthy. All the specimens were fixed with 4% poly-paraformaldehyde, embedded in the paraffin, and made to slices for the immuno-histochemical analysis. At last, positive cells in different areas of the disc tissues, including endplatem, fibrosus annulus and nucleus, were counted and analyzed separately in twenty HP ( 400×) and then added to make statistical analysis. The expression of TNF-α, IL-1βand IL-6 were detected by immuno-Histochemistology, and the results were calculated by image procedure software. The data were dealt with SPSS 13.0.Results1. In the test group, the positive cases for TNF-α, were17; in the control gr- oup, there were only 1 positive case in all the 17 cases. There was significant difference between the two groups (P<0.05).2. In the test group, the positive cases for IL-1β, were14; in the control gro- up, there were only 2 positive cases. There was difference between the two gr- oups(P < 0.05).3. In the test group, the positive cases for IL-6, were 13; in the control gro- up, there were also 1 positive cases. There was difference between the two gr- oups by using SPSS 13. 0 statistics software (P<0.05).4. In the test group, the positive cases for TNF-α, IL-1βand IL -6 were 9; in the control group, there were no positive cells in all the 17 cases. There was difference between the two groups by using SPSS 13. 0 statistics software..5. The results of the immune-chemistry showed a very good statistic differ- ence exited among all the groups.Conclusion: The tissues of degenerative disc could produce TNF-α, IL-1β, and IL-6 cytokines, which were mainly found in the granulation tissue of circ- umambient intervertebral discs. The positive cells were mainly fibroblasts, ca- rtilage cells and lymphocytes. These cytokines may play an important role in the degeneration of degenerative lumbar scoliosis.