EFFECT OF INTRAVENOUS MANNITOL OR DEXAMETHASONE ON LOW BACK AND LEG PAIN AFTER LUMBAR FUSION SURGERY_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHENGYong ,  WANGJian , YUANChao , ZHENGWenjie , LIChangqing , ZHANGZhengfeng , ZHOUYue

Department of Orthopaedics, Xinqiao Hospital, the Third Military Medical University, Chongqing, 400037, P. R. China;

Corresponding author：

WANGJian, Email: tonywjxq@aliyun.com

Keywords：

Low back and leg pain; Degenerative lumbar disease; Mannitol; Dexamethasone; Minimally invasive transforaminal lumbar interbody fusion

DOI：

10.7507/1002-1892.20140122

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Objective To compare the effect of intravenous 20% mannitol or dexamethasone (DM) on low back and leg pain after minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Methods Between October 2012 and September 2013, 100 patients with degenerative lumbar diseases underwent MI-TLIF and percutaneous pedicle screw fixation. All patients were randomly divided into 3 groups:34 patients received intravenous 20% mannitol after operation (mannitol group); 32 patients received intravenous DM after operation (DM group); and 34 patients received neither dehydrating agent nor steroid after operation (control group). There was no significant difference in gender, age, disease duration, clinical symptoms, lesion types, and lesion segments between groups (P>0.05). The serum levels of inflammatory factors[tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and IL-6] were measured by ELISA at pre-operation and 3, 24, 48, 72, and 96 hours after operation. Low back and leg pain was determined by using visual analogue scale (VAS) score after operation. Results All procedures were smoothly performed without major complications of nerve root injury, hematoma, or infection. There was no significant difference in operation time and intraoperative blood loss between groups (P>0.05). The VAS score of low back pain showed no significant difference between groups at all time points after operation (P>0.05); the VAS score of leg pain in the DM group was significantly lower than that in the control group at all time points (P<0.05), and than those in the mannitol group at 3, 24, 48, and 96 hours after operation (P<0.05). The serum level of TNF-α in the DM group was significantly lower than that in the control group at all time points (P<0.05), and than that in the mannitol group at 3, 48, 72, and 96 hours after operation (P<0.05). The serum level of IL-1β in the DM group was significantly lower than that in the control group at 3, 24, 48, and 72 hours after operation (P<0.05), and than that in the mannitol group at all time points after operation (P<0.05). The serum level of IL-6 in the DM group was significantly lower than that in the control group at 3 and 24 hours after operation (P<0.05), and than that in the mannitol group at 3, 24, and 48 hours after operation (P<0.05). Conclusion Intravenous 20% mannitol may has no effect on postoperative low back and leg pain, while DM can markedly relieve leg pain after MI-TLIF.

Citation： ZHENGYong, WANGJian, YUANChao, ZHENGWenjie, LIChangqing, ZHANGZhengfeng, ZHOUYue. EFFECT OF INTRAVENOUS MANNITOL OR DEXAMETHASONE ON LOW BACK AND LEG PAIN AFTER LUMBAR FUSION SURGERY. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(5): 544-548. doi: 10.7507/1002-1892.20140122 Copy

1.	Schwender JD, Holly LT, Rouben DP, et al. Minimally invasive transforaminal lumbar interbody fusion (TLIF):technical feasibility and initial results. J Spinal Disord Tech, 2005, 18 Suppl:S1-6.
2.	Scheufler KM, Dohmen H, Vougioukas VI. Percutaneous transforaminal lumbar interbody fusion for the treatment of degenerative lumbar instability. Neurosurgery, 2007, 60(4 suppl 2):203-213.
3.	Wang J, Zhou Y, Zhang ZF, et al. Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J, 2010, 19(10):1780-1784.
4.	Galloway EB, Jensen RL, Dailey AT, et al. Role of topical steroids in reducing dysfunction after nerve injury. Laryngoscope, 2000, 110(11):1907-1910.
5.	Watters WC 3rd, Temple AP, Granberry M. The use of dexamethasone in primary lumbar disc surgery. A prospective, randomized, double-blind study. Spine (Phila Pa 1976), 1989, 14(4):440-442.
6.	Aminmansour B, Khalili HA, Ahmadi J, et al. Effect of high-dose intravenous dexamethasone on postlumbar discectomy pain. Spine (Phila Pa 1976), 2006, 31(21):2415-2417.
7.	Debi R, Halperin N, Mirovsky Y. Local application of steroids following lumbar discectomy. J Spinal Disord Tech, 2002, 15(4):273-276.
8.	Lundin A, Magnuson A, Axelsson K, et al. The effect of perioperative corticosteroids on the outcome of microscopic lumbar disc surgery. Eur Spine J, 2003, 12(6):625-630.
9.	Langmayr JJ, Obwegeser AA, Schwarz AB, et al. Intrathecal steroids to reduce pain after lumbar disc surgery:A double-blind, placebo-controlled prospective study. Pain, 1995, 62(3):357-361.
10.	杨进, 孔清泉, 宋跃明, 等. 微创小切口与开放经椎间孔腰椎椎间融合术治疗单节段腰椎退变疾患的近期疗效比较. 中国修复重建外科杂志, 2013, 27(3):262-267.
11.	Cui LY, Liu SL, Ding Y, et al. IL-1beta sensitizes rat intervertebral disc cells to Fas ligand mediated apoptosis in vitro. Acta Pharmacol Sin, 2007, 28(10):1671-1676.
12.	Weiler C, Nerlich AG, Bachmeier BE, et al. Expression and distribution of tumor necrosis factor alpha in human lumbar intervertebral discs:a study in surgical specimen and autopsy controls. Spine (Phila Pa 1976), 2005, 30(1):44-54.
13.	Seguin CA, Pilliar RM, Roughley PJ, et al. Tumor necrosis factor-alpha modulates matrix production and catabolism in nucleus pulposus tissue. Spine (Phila Pa 1976), 2005, 30(17):1940-1948.
14.	Mabuchi T, Kojima H, Abe T, et al. Membrane-associated prostaglandin E synthase-1 is required for neuropathic pain. Neuroreport, 2004, 15(9):1395-1398.
15.	Briegel J, Jochum M, Gippner-Steppert C, et al. Immunomodulation in septic shock:hydrocortisone differentially regulates cytokine responses. J Am Soc Nephrol, 2001, 12 Suppl 17:S70-74.
16.	Auphan N, DiDonato JA, Rosette C, et al. Immunosuppression by glucocorticoids:inhibition of NF-kappa B activity through induction of I kappa B synthesis. Science, 1995, 270(5234):286-290.
17.	Wilson SJ, Wallin A, Della-Cioppa G, et al. Effects of budesonide and formoterol on NF-kappaB, adhesion molecules, and cytokines in asthma. Am J Respir Crit Care Med, 2001, 164(6):1047-1052.
18.	Ozgur BM, Yoo K, Rodriguez G, et al. Minimally-invasive technique for transforaminal lumbar interbody fusion (TLIF). Eur Spine J, 2005, 14(9):887-894.
19.	Waldron NH, Jones CA, Gan TJ, et al. Impact of perioperative dexamethasone on postoperative analgesia and side-effects:systematic review and meta-analysis. Br J Anaesth, 2013, 110(2):191-200.
20.	Pasternak JJ, McGregor DG, Lanier WL. Effect of single-dose dexamethasone on blood glucose concentration in patients undergoing craniotomy. J Neurosurg Anesthesiol, 2004, 16(2):122-125.

1. Schwender JD, Holly LT, Rouben DP, et al. Minimally invasive transforaminal lumbar interbody fusion (TLIF):technical feasibility and initial results. J Spinal Disord Tech, 2005, 18 Suppl:S1-6.
2. Scheufler KM, Dohmen H, Vougioukas VI. Percutaneous transforaminal lumbar interbody fusion for the treatment of degenerative lumbar instability. Neurosurgery, 2007, 60(4 suppl 2):203-213.
3. Wang J, Zhou Y, Zhang ZF, et al. Comparison of one-level minimally invasive and open transforaminal lumbar interbody fusion in degenerative and isthmic spondylolisthesis grades 1 and 2. Eur Spine J, 2010, 19(10):1780-1784.
4. Galloway EB, Jensen RL, Dailey AT, et al. Role of topical steroids in reducing dysfunction after nerve injury. Laryngoscope, 2000, 110(11):1907-1910.
5. Watters WC 3rd, Temple AP, Granberry M. The use of dexamethasone in primary lumbar disc surgery. A prospective, randomized, double-blind study. Spine (Phila Pa 1976), 1989, 14(4):440-442.
6. Aminmansour B, Khalili HA, Ahmadi J, et al. Effect of high-dose intravenous dexamethasone on postlumbar discectomy pain. Spine (Phila Pa 1976), 2006, 31(21):2415-2417.
7. Debi R, Halperin N, Mirovsky Y. Local application of steroids following lumbar discectomy. J Spinal Disord Tech, 2002, 15(4):273-276.
8. Lundin A, Magnuson A, Axelsson K, et al. The effect of perioperative corticosteroids on the outcome of microscopic lumbar disc surgery. Eur Spine J, 2003, 12(6):625-630.
9. Langmayr JJ, Obwegeser AA, Schwarz AB, et al. Intrathecal steroids to reduce pain after lumbar disc surgery:A double-blind, placebo-controlled prospective study. Pain, 1995, 62(3):357-361.
10. 杨进, 孔清泉, 宋跃明, 等. 微创小切口与开放经椎间孔腰椎椎间融合术治疗单节段腰椎退变疾患的近期疗效比较. 中国修复重建外科杂志, 2013, 27(3):262-267.
11. Cui LY, Liu SL, Ding Y, et al. IL-1beta sensitizes rat intervertebral disc cells to Fas ligand mediated apoptosis in vitro. Acta Pharmacol Sin, 2007, 28(10):1671-1676.
12. Weiler C, Nerlich AG, Bachmeier BE, et al. Expression and distribution of tumor necrosis factor alpha in human lumbar intervertebral discs:a study in surgical specimen and autopsy controls. Spine (Phila Pa 1976), 2005, 30(1):44-54.
13. Seguin CA, Pilliar RM, Roughley PJ, et al. Tumor necrosis factor-alpha modulates matrix production and catabolism in nucleus pulposus tissue. Spine (Phila Pa 1976), 2005, 30(17):1940-1948.
14. Mabuchi T, Kojima H, Abe T, et al. Membrane-associated prostaglandin E synthase-1 is required for neuropathic pain. Neuroreport, 2004, 15(9):1395-1398.
15. Briegel J, Jochum M, Gippner-Steppert C, et al. Immunomodulation in septic shock:hydrocortisone differentially regulates cytokine responses. J Am Soc Nephrol, 2001, 12 Suppl 17:S70-74.
16. Auphan N, DiDonato JA, Rosette C, et al. Immunosuppression by glucocorticoids:inhibition of NF-kappa B activity through induction of I kappa B synthesis. Science, 1995, 270(5234):286-290.
17. Wilson SJ, Wallin A, Della-Cioppa G, et al. Effects of budesonide and formoterol on NF-kappaB, adhesion molecules, and cytokines in asthma. Am J Respir Crit Care Med, 2001, 164(6):1047-1052.
18. Ozgur BM, Yoo K, Rodriguez G, et al. Minimally-invasive technique for transforaminal lumbar interbody fusion (TLIF). Eur Spine J, 2005, 14(9):887-894.
19. Waldron NH, Jones CA, Gan TJ, et al. Impact of perioperative dexamethasone on postoperative analgesia and side-effects:systematic review and meta-analysis. Br J Anaesth, 2013, 110(2):191-200.
20. Pasternak JJ, McGregor DG, Lanier WL. Effect of single-dose dexamethasone on blood glucose concentration in patients undergoing craniotomy. J Neurosurg Anesthesiol, 2004, 16(2):122-125.

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Chinese Journal of Reparative and Reconstructive Surgery

EFFECT OF INTRAVENOUS MANNITOL OR DEXAMETHASONE ON LOW BACK AND LEG PAIN AFTER LUMBAR FUSION SURGERY

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