椎間板性腰痛の慢性化機序に関する考察
椎間板は非特異的腰痛の一因となる．腰痛のほとんどは自然に改善するが，臨床上問題となるのは腰痛が慢性化する病態である．腰痛の慢性化の機序については，急性腰痛が遷延化した病態と，持続的にトリガーとなる損傷が繰り返し起こる病態の可能性がある．これらの病態に，椎間板内への神経伸長，椎間板内に発現する炎症性サイトカインや神経成長因子といった疼痛関連物質とその発現に関与するマクロファージ，椎間板に持続的に加わるメカニカルストレスが関与している可能性がある．...
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| Published in | Journal of Spine Research Vol. 11; no. 6; pp. 878 - 882 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本脊椎脊髄病学会
20.06.2020
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 1884-7137 2435-1563 |
| DOI | 10.34371/jspineres.2020-0502 |
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| Abstract | 椎間板は非特異的腰痛の一因となる．腰痛のほとんどは自然に改善するが，臨床上問題となるのは腰痛が慢性化する病態である．腰痛の慢性化の機序については，急性腰痛が遷延化した病態と，持続的にトリガーとなる損傷が繰り返し起こる病態の可能性がある．これらの病態に，椎間板内への神経伸長，椎間板内に発現する炎症性サイトカインや神経成長因子といった疼痛関連物質とその発現に関与するマクロファージ，椎間板に持続的に加わるメカニカルストレスが関与している可能性がある． |
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| AbstractList | 椎間板は非特異的腰痛の一因となる．腰痛のほとんどは自然に改善するが，臨床上問題となるのは腰痛が慢性化する病態である．腰痛の慢性化の機序については，急性腰痛が遷延化した病態と，持続的にトリガーとなる損傷が繰り返し起こる病態の可能性がある．これらの病態に，椎間板内への神経伸長，椎間板内に発現する炎症性サイトカインや神経成長因子といった疼痛関連物質とその発現に関与するマクロファージ，椎間板に持続的に加わるメカニカルストレスが関与している可能性がある． |
| Author | 中脇, 充章 高相, 晶士 内田, 健太郎 宮城, 正行 井上, 玄 川久保, 歩 |
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| References | 18) Ulrich JA, Liebenberg EC, Thuillier DU, et al: ISSLS prize winner: repeated disc injury causes persistent inflammation. Spine. 2007; 32: 2812-2819 11) Miyagi M, Ishikawa T, Kamoda H, et al: Disk Dynamic Compression in Rats Produces Long-Lasting Increases in Inflammatory Mediators in Disks and Induces Long-Lasting Nerve Injury and Regeneration of the Afferent Fibers Innervating Disks: A Pathomechanism for Chronic Diskogenic Low Back Pain. Spine. 2012; 37 (21): 1810-1818 17) Miyagi M, Ishikawa T, Orita S, et al: Disk injury in rats produces persistent increases in pain-related neuropeptides in dorsal root ganglia and spinal cord glia but only transient increases in inflammatory mediators: pathomechanism of chronic diskogenic low back pain. Spine. 2011; 36 (26): 2260-2266 6) Freemont AJ, Peacock TE, Goupille P, et al: Nerve ingrowth into diseased intervertebral disc in chronic back pain. Lancet. 1997; 350: 178-181 12) Miyagi M, Uchida K, Takano S, et al: Macrophage-derived inflammatory cytokines regulate growth factors and pain-related molecules in mice with intervertebral disc injury. J Orthop Res. 2018; 10.1002/jor.23888 1) Nachemson A: Epidemiology and the economics of low back pain. The Lumbar Spine. In Herkowits HN, Dvorak J, Bell G, et al, eds. 3rd edn. Philadelphia, Lippincott Williams & Wilkins, pp3-10, 2004 3) Schwarzer AC, Aprill CN, Derby R, et al: The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine. 1995; 20: 1878-1881 7) Miyagi M, Millecamps M, Danco AT, et al: Increased Innervation and Sensory Nervous System Plasticity in a Mouse Model of Low Back Pain due to Intervertebral Disc Degeneration. Spine. 2014; 39 (17): 1345-1354 15) Nakazawa KR, Walter BA, Laudier DM, et al: Accumulation and localization of macrophage phenotypes with human intervertebral disc degeneration. Spine J. 2018; 18: 343-356 19) 腰痛診療ガイドライン2019改訂第2版. 日本整形外科学会診療ガイドライン委員会・腰痛診療ガイドライン策定委員会編. 10) Miyagi M, Ishikawa T, Orita S, et al: Disk injury in rats produces persistent increases in neuropeptides in dorsal root ganglia and spinal cord glia but only transient increases in inflammatory mediators: patho-mechanism of chronic diskogenic low back pain. Spine. 2011; 36 (26): 2260-2266 4) Suzuki H, Kanchiku T, Imajo Y, et al: Diagnosis and Characters of Non-Specific Low Back Pain in Japan: The Yamaguchi Low Back Pain Study. PLoS One. 2016; 11 (8): e0160454 14) 西田康太郎, 金山修一, 高田 徹, 他: 椎間板の免疫特権と腰痛との関係. 日本腰痛会誌. 2008; 14 (1): 50-57 16) Kawakubo A, Uchida K, Miyagi M, et al: Investigation of resident and recruited macrophages following disc injury in mice. J Orthop Res. 2020; 10.1002/jor.24590. in press 9) Burke JG, Watson RW, McCormack D, et al: Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Joint Surg Br. 2002; 84: 196-201 8) Kang JD, Georgescu HI, McIntyre-Larkin L, et al: Herniated lumbar intervertebral discs spontaneously produce matrix metalloproteinases, nitric oxide, interleukin-6, and prostaglandin E2. Spine. 1996; 21: 271-277 2) Hall H, McIntosh G: Low back pain (acute). BMJ Clin Evid. 2008; 2008: pii: 1102 13) Nakawaki M, Uchida K, Miyagi M, et al: Changes in Nerve Growth Factor Expression and Macrophage Phenotype Following Intervertebral Disc Injury in Mice. J Orthop Res. 2019; 37 (8): 1798-1804. doi: 10.1002/jor.24308 5) 篠原寛休: 腰部椎間板障害の研究特に椎間板内神経終末の組織学的検討. 日本整形外科学会雑誌. 1970; 44 (8): 553-570 |
| References_xml | – reference: 18) Ulrich JA, Liebenberg EC, Thuillier DU, et al: ISSLS prize winner: repeated disc injury causes persistent inflammation. Spine. 2007; 32: 2812-2819 – reference: 17) Miyagi M, Ishikawa T, Orita S, et al: Disk injury in rats produces persistent increases in pain-related neuropeptides in dorsal root ganglia and spinal cord glia but only transient increases in inflammatory mediators: pathomechanism of chronic diskogenic low back pain. Spine. 2011; 36 (26): 2260-2266 – reference: 15) Nakazawa KR, Walter BA, Laudier DM, et al: Accumulation and localization of macrophage phenotypes with human intervertebral disc degeneration. Spine J. 2018; 18: 343-356 – reference: 14) 西田康太郎, 金山修一, 高田 徹, 他: 椎間板の免疫特権と腰痛との関係. 日本腰痛会誌. 2008; 14 (1): 50-57 – reference: 13) Nakawaki M, Uchida K, Miyagi M, et al: Changes in Nerve Growth Factor Expression and Macrophage Phenotype Following Intervertebral Disc Injury in Mice. J Orthop Res. 2019; 37 (8): 1798-1804. doi: 10.1002/jor.24308 – reference: 10) Miyagi M, Ishikawa T, Orita S, et al: Disk injury in rats produces persistent increases in neuropeptides in dorsal root ganglia and spinal cord glia but only transient increases in inflammatory mediators: patho-mechanism of chronic diskogenic low back pain. Spine. 2011; 36 (26): 2260-2266 – reference: 2) Hall H, McIntosh G: Low back pain (acute). BMJ Clin Evid. 2008; 2008: pii: 1102 – reference: 7) Miyagi M, Millecamps M, Danco AT, et al: Increased Innervation and Sensory Nervous System Plasticity in a Mouse Model of Low Back Pain due to Intervertebral Disc Degeneration. Spine. 2014; 39 (17): 1345-1354 – reference: 8) Kang JD, Georgescu HI, McIntyre-Larkin L, et al: Herniated lumbar intervertebral discs spontaneously produce matrix metalloproteinases, nitric oxide, interleukin-6, and prostaglandin E2. Spine. 1996; 21: 271-277 – reference: 16) Kawakubo A, Uchida K, Miyagi M, et al: Investigation of resident and recruited macrophages following disc injury in mice. J Orthop Res. 2020; 10.1002/jor.24590. in press – reference: 9) Burke JG, Watson RW, McCormack D, et al: Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Joint Surg Br. 2002; 84: 196-201 – reference: 5) 篠原寛休: 腰部椎間板障害の研究特に椎間板内神経終末の組織学的検討. 日本整形外科学会雑誌. 1970; 44 (8): 553-570 – reference: 3) Schwarzer AC, Aprill CN, Derby R, et al: The prevalence and clinical features of internal disc disruption in patients with chronic low back pain. Spine. 1995; 20: 1878-1881 – reference: 12) Miyagi M, Uchida K, Takano S, et al: Macrophage-derived inflammatory cytokines regulate growth factors and pain-related molecules in mice with intervertebral disc injury. J Orthop Res. 2018; 10.1002/jor.23888 – reference: 6) Freemont AJ, Peacock TE, Goupille P, et al: Nerve ingrowth into diseased intervertebral disc in chronic back pain. Lancet. 1997; 350: 178-181 – reference: 1) Nachemson A: Epidemiology and the economics of low back pain. The Lumbar Spine. In Herkowits HN, Dvorak J, Bell G, et al, eds. 3rd edn. Philadelphia, Lippincott Williams & Wilkins, pp3-10, 2004 – reference: 4) Suzuki H, Kanchiku T, Imajo Y, et al: Diagnosis and Characters of Non-Specific Low Back Pain in Japan: The Yamaguchi Low Back Pain Study. PLoS One. 2016; 11 (8): e0160454 – reference: 11) Miyagi M, Ishikawa T, Kamoda H, et al: Disk Dynamic Compression in Rats Produces Long-Lasting Increases in Inflammatory Mediators in Disks and Induces Long-Lasting Nerve Injury and Regeneration of the Afferent Fibers Innervating Disks: A Pathomechanism for Chronic Diskogenic Low Back Pain. Spine. 2012; 37 (21): 1810-1818 – reference: 19) 腰痛診療ガイドライン2019改訂第2版. 日本整形外科学会診療ガイドライン委員会・腰痛診療ガイドライン策定委員会編. |
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| SubjectTerms | メカニカルストレス 慢性腰痛 椎間板深層神経伸長 疼痛関連物質 |
| Title | 椎間板性腰痛の慢性化機序に関する考察 |
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