vasoactive-intestinal-peptide and Low-Back-Pain

Straight leg raising was recorded before myelography in 77 patients. At myelography, samples of cerebrospinal fluid were drawn and later analyzed for neuropeptides vasoactive intestinal polypeptide and somatostatin.. The study sought to examine correlations, if any, between a positive straight leg raising test and cerebrospinal fluid neuropeptide levels.. The straight leg raising test was recorded for all patients before a myelography examination was performed because of intractable leg pain symptoms. Forty-seven of the patients were men and 30 were women. Cerebrospinal fluid samples were obtained from all patients upon myelography. Levels of the neuropeptides vasoactive intestinal polypeptide and somatostatin were analyzed in a blind manner by radioimmunoassay, using commercially available radioimmunoassay kits.. The results are compatible with previous observations that suggest cerebrospinal neuropeptide levels are altered in conjunction with neural injury or pain syndromes. In the present mixed back pain patient population, which included radicular pain symptoms due to disc herniation and lumbar stenosis, alterations in vasoactive intestinal peptide levels in particular were observed with a positive straight leg raising test.. Nerve root injury, as suggested by a positive straight leg raising test, appears to be neurochemically linked to altered cerebrospinal fluid vasoactive intestinal peptide levels.

Topics: Female; Humans; Leg; Low Back Pain; Male; Middle Aged; Myelography; Radioimmunoassay; Somatostatin; Spinal Nerve Roots; Vasoactive Intestinal Peptide

To study the pathogenesis of the pain of discography and the discogenic low back pain.. 19 specimens of lumbar intervertebral discs from 17 patients with discogenic low back pain during posterior lumbar interbody fusion, and 12 physiologically aging discs and 10 normal control discs were collected to investigate the morphologic features and innervation containing neuropeptides substance P (SP), neural filament (NF), and vasoactive-intestinal peptide (VIP).. The distinct morphologic characteristic of the disc from the patient with discogenic low back pain was the formation of the strip zone of vascularized granulation tissue from the nucleus pulposus to the outer part of the annulus fibrosus in which there was one or several fissures. The structure of annulus fibrosus beyond the strip zone of granulation tissue was basically normal. The structures of the aging discs and the control discs showed the age-related changes. The innervation of SP, NF and VIP immunoreactive nerve fibers in the painful discs was more extensive compared with the aging discs and the control discs. The nerve in growth deep into annulus fibrosus and nucleus pulposus was observed mainly along the strip zone of granulation tissue in the painful discs.. Findings indicate that the strip zone of granulation tissue with extensive innervation in the posterior part of the painful disc is the original site of the pain of discography and the discogenic low back pain. The strip zone of granulation tissue might originate from the injury and subsequent reparation of the margin of annulus fibrosus. The difference of the aging disc and painful disc which can not be differed each other on MRI is the formation of the strip zone of granulation tissue along tear histologically in posterior part of the painful disc.

Topics: Adult; Female; Humans; Intervertebral Disc; Low Back Pain; Lumbar Vertebrae; Male; Middle Aged; Neurofilament Proteins; Substance P; Vasoactive Intestinal Peptide

It has been thought that lumbar intervertebral discs were innervated segmentally. We have previously shown that the L5-L6 intervertebral disc in the rat is innervated bilaterally from the L1 and L2 dorsal root ganglia through the paravertebral sympathetic trunks, but the pathways between the disc and the paravertebral sympathetic trunks were unknown. We have now studied the spines of 17 rats to elucidate the exact pathways. We examined serial sections of the lumbar spine using immunohistochemistry for calcitonin gene-related peptide, a sensory nerve marker. We showed that these nerve fibres from the intervertebral disc ran through the sinuvertebral nerve into the rami communicantes, not into the corresponding segmental spinal nerve. In the rat, sensory information from the lumbar intervertebral discs is conducted through rami communicantes. If this innervation pattern applies to man, simple decompression of the corresponding nerve root will not relieve discogenic pain. Anterior interbody fusion, with the denervation of rami communicantes, may be effective for such low back pain.

Topics: Animals; Biomarkers; Calcitonin Gene-Related Peptide; Dopamine beta-Hydroxylase; Ganglia, Spinal; Humans; Immunohistochemistry; Intervertebral Disc; Low Back Pain; Lumbar Vertebrae; Nerve Fibers; Neural Pathways; Neurons, Afferent; Rats; Rats, Sprague-Dawley; Spinal Fusion; Spinal Nerve Roots; Spinal Nerves; Sympathetic Nervous System; Vasoactive Intestinal Peptide

The rabbit dorsal root ganglion is an important model of pain mechanisms in the human spine. A morphometric model of the normal rabbit dorsal root ganglion was constructed to provide quantitative comparisons with injured ganglia. Lumbar ganglia were studied under light and electron microscopy using simple stereologic methods. Neuronal diameter ranged from 18 to 85 microns, with 60% between 30 and 50 microns. Neurons constituted approximately 30% of dorsal root ganglion volume, and neuronal nuclei accounted for 14% of neuronal volume and 4% of dorsal root ganglion volume. Contributions from organelles to dorsal root ganglion volume were: mitochondria, 1.5%; rough endoplasmic reticulum, 9.4%; lysosomes, 0.2%; golgi, 0.5%. This morphometric model facilitates quantitative analysis of ganglia exposed to direct or indirect stimuli, providing important information on the structural changes that influence pain production.

Topics: Animals; Ganglia, Spinal; Low Back Pain; Microscopy, Electron; Models, Neurological; Neurons; Pain; Rabbits; Substance P; Vasoactive Intestinal Peptide; Vibration