Correlation of tumor necrosis factor-α expression with pain level in degenerative lumbar canal stenosis patients

BACKGROUND: Pain in degenerative lumbar canal stenosis is caused by osteoarthritis of a facet joint and intervertebral disc degeneration. Some inflammatory mediators such as tumor necrosis factor (TNF)-α are present in degenerative lumbar canal stenosis. AIM: This study aimed to evaluate the correlation of pain and functional pre-operative scores with the expression of TNF-α in nucleus pulposus, annulus fibrosus, and facet joints. METHODS: Patients diagnosed with degenerative lumbar canal stenosis and planned for surgical treatment were included in this study. Patients with a history of fracture, neoplasm, and/or infection of the spine were excluded. Tissue samples were collected from the nucleus pulposus, annulus fibrosus, facet joint, flavum ligament, and paraspinal muscles of the spine during the surgery. TNF-α expression was examined semi-quantitively and correlated with the axial and radicular pain that was measured using the Visual Analog Scale (VAS) score. The result was then statistically analyzed. RESULTS: The expression of TNF-α in the paraspinal muscle was significantly higher compared to other locations. TNF-α expression in the facet joint group was significantly correlated with the intensity of low back pain measured by VAS score (r = 0.893, p < 0.001), and pre-operative functional outcome based on Oswestry Disability Index (ODI) (r = 0.948, p < 0.001). CONCLUSION: TNF-α expression, especially in the facet joint, is significantly associated with the pain intensity and pre-operative ODI that allow pain reduction with less invasive treatment in lumbar canal stenosis patients. © 2021 Yudha Mathan Sakti, Rahadyan Magetsari, David Yosua Parulian Hutahaean, Galih Prasetya Sakadewa, Paramita Dyah Lasmana, Nicolaas C. Budhiparama, Ery Kus Dwianingsih.