Ultra‑purified alginate gel implantation decreases inflammatory cytokine levels, prevents intervertebral disc degeneration, and reduces acute pain after discectomy

Scientific Reports, 2021 · DOI: 10.1038/s41598-020-79958-9 · Published: January 11, 2021

Simple Explanation

This study investigates a new treatment for back pain and disc degeneration after disc removal surgery (discectomy). The treatment involves implanting a special gel made from ultra-purified alginate (UPAL) into the damaged disc. The researchers tested this UPAL gel in rats and rabbits that had a procedure mimicking a discectomy. They looked at inflammation markers, nerve growth, and disc health. The results showed that the UPAL gel reduced inflammation, prevented disc degeneration, and lowered pain levels in the animals. This suggests that UPAL gel could be a promising treatment for people with back pain after discectomy.

Study Duration

28 days

Participants

45 rats and 24 rabbits

Evidence Level

Level 2: Animal Study

Key Findings

1
UPAL gel implantation suppressed TNF-α and IL-6 production in both rat and rabbit models of discectomy.
2
UPAL gel downregulated TrkA expression, suggesting a reduction in nerve ingrowth and potentially discogenic pain.
3
UPAL gel implantation inhibited IVD degeneration and reduced nociceptive behaviour in a rat caudal NP punch model.

Research Summary

This study aimed to assess whether UPAL gel implantation reduces inflammatory cytokine levels, prevents intervertebral disc degeneration, and reduces acute pain after discectomy in rat and rabbit discectomy models. UPAL gel implantation inhibited TNF-α and IL-6 production and downregulated TrkA receptor expression in both rat and rabbit models. The present findings indicate the utility of UPAL gel as treatment for IVD herniation that not only prevents IVD tissue degeneration, but also for suppresses inflammation, potentially reduced neoinnervation as suggested by the downregulation of TrkA expression, and alleviates pain induced IVD injury after discectomy.

Practical Implications

Potential New Treatment for Post-Discectomy Pain

UPAL gel implantation shows promise as a new treatment to reduce low back pain and prevent disc degeneration following discectomy.

Reduction of Inflammation and Nerve Ingrowth

The gel's ability to suppress inflammatory cytokines and downregulate TrkA expression suggests it can reduce inflammation and nerve ingrowth into the disc, key factors in discogenic pain.

Prophylactic Treatment for Discogenic Pain

By preventing IVD degeneration, UPAL gel implantation may serve as a prophylactic treatment for discogenic pain.

Study Limitations

1
No direct causal relationship has been demonstrated between the reduced production of proinflammatory cytokines and reduced pain-related behaviours in the rat NP punch model.
2
Rabbit models are not suitable for the assessment of pain-related behaviour because there are still no quantitative analysis methods available.
3
It is unclear how the present behavioural nociception assays would be relevant to the human lumbar spine which has vastly different anatomy and where pain is not often provoked by direct stimulation.

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