Pain Characteristics of the Posterior Longitudinal Ligament in Percutaneous Endoscopic Lumbar Discectomy and its Significance: A Retrospective Study

IF 4.1 2区医学 Q1 CLINICAL NEUROLOGY Pain and Therapy Pub Date : 2024-09-14 DOI:10.1007/s40122-024-00656-9

Kaining Zhang, Yun Yang, Wen Yu, Yubin Qi, Yanjun Ren, Yingguang Wu, Wa Shan, Fengxiang Zhu, Feifei Chen

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Abstract

Introduction

In percutaneous endoscopic lumbar discectomy (PELD), pain occurs when the posterior longitudinal ligament (PLL) is exposed, removed, and decompressed. However, pain characteristics of the PLL stimulated in PELD have not been reported.

Methods

A total of 932 patients underwent PELD under local anesthesia. Pain distribution and intensity were recorded on a posterior body diagram during the operation. Pain intensity was assessed by the visual analog scale scores for the back (VAS-B). The PLL specimens were collected and observed using hematoxylin–eosin (HE) staining and immunohistochemistry.

Results

Patients with lumbar disc herniation (LDH) at L4/5 and L5/S1 had pain foci in different regions. The mean VAS-B scores between the ventral and dorsal sides of the PLL were 6.14 ± 0.97 and 4.80 ± 1.15, respectively (P < 0.05). The distribution of nociceptive nerve fibers in the dorsal side was uniform and scattered, while those in the ventral side were mainly distributed near the outer surface of the annulus fibrosus. The positive expression of substance P (SP) and calcitonin gene-related peptide (CGRP) was higher in the ventral side of the PLL than in the dorsal side (P < 0.0001).

Conclusions

Differences in pain distribution and intensity were observed when the PLL was incited at different spinal levels during PELD surgery.

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经皮内窥镜腰椎间盘切除术中后纵韧带的疼痛特征及其意义：回顾性研究

引言在经皮内窥镜腰椎间盘切除术（PELD）中，后纵韧带（PLL）被暴露、切除和减压时会产生疼痛。方法共有 932 名患者在局部麻醉下接受了 PELD。在手术过程中，疼痛的分布和强度被记录在后体图上。疼痛强度通过背部视觉模拟量表（VAS-B）进行评估。结果L4/5和L5/S1腰椎间盘突出症（LDH）患者的疼痛灶分布在不同的区域。PLL 腹侧和背侧的平均 VAS-B 评分分别为 6.14 ± 0.97 和 4.80 ± 1.15（P < 0.05）。背侧的痛觉神经纤维分布均匀且分散，而腹侧的痛觉神经纤维主要分布在纤维环外侧附近。P 物质（SP）和降钙素基因相关肽（CGRP）在 PLL 腹侧的阳性表达高于背侧（P < 0.0001）。

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来源期刊

Pain and Therapy CLINICAL NEUROLOGY-

CiteScore

6.60

自引率

5.00%

发文量

110

审稿时长

6 weeks

期刊介绍： Pain and Therapy is an international, open access, peer-reviewed, rapid publication journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of pain therapies and pain-related devices. Studies relating to diagnosis, pharmacoeconomics, public health, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to, acute pain, cancer pain, chronic pain, headache and migraine, neuropathic pain, opioids, palliative care and pain ethics, peri- and post-operative pain as well as rheumatic pain and fibromyalgia. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports, trial protocols, short communications such as commentaries and editorials, and letters. The journal is read by a global audience and receives submissions from around the world. Pain and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.