Effects of systemic and local biochemical markers on disease clinic and post-surgical recovery in cases of lumbar spondylolisthesis

One of the most common complaints in clinical practice is low back pain and accompanying spine degenerative diseases. Many studies had been done to understand the pathophysiology of spinal degenerative diseases (1,2,3,4,5). Changes such as hypertrophy in the vertebral facet joints, hypertrophy and calcifications in the flavum ligaments in a person with degenerative spine disease cause narrowing of the spinal cord, compression of the nerve roots and clinical findings that reduce the standard of living. The roles of proinflammatory and matrix metalloproteinases (MMPs) in degenerative changes in the flavum ligament, facet joints and intervertebral disc were investigated in studies (1,3,4). In these studies, it has been shown that facet joints are affected by degeneration in the inflammatory process, and that some proinflammatory cytokines are at higher levels in the bloodstream in degenerative stenosis patients and patients with degenerative disc disease (5). It has been found that many proinflammatory cytokines, including tumor necrosis factor-alpha (TNF-α), interleukin (IL-1, IL-6, IL-17, and interferon-gamma (IFN-γ)), are elevated in degenerative or herniated inverteral discs (6 -9). It has been reported that the levels of some of the chemokines involved in many inflammatory processes are increased in the degenerative ligamentum flavum (4). Matrix metalloproteinases are a family of enzymes that contain more than twenty enzymes responsible for the degradation or modification of the extracellular matrix. Studies on disc degeneration have shown that matrix metalloproteinases such as MMP-1, MMP-3, MMP-7 and MMP-13 are associated with activity and expressions, and their levels are associated with an increase in the severity of degeneration (10-13). MMP-3 has a role in the destruction of the articular cartilage matrix of rheumatoid arthritis, osteoarthritis and degenerated lumbar disc tissues (14). It is also thought that oxidative stress plays an important role in this degenerative process. Oxidative stress is known to damage lipids, proteins and DNA in cells as a result of the balance between oxidant and anti-oxidant systems being disrupted in favor of oxidant systems. Dechsupa et al. found that oxidative DNA damage was higher in hypertrophic ligamentum flavum in patients with lumbar spinal stenosis compared to nonpathological ligamentum flavum (15). Another study found that the decrease in catalase expression was associated with ligamentum flavum hypertrophy due to lumbar spinal canal stenosis (16). In our study, the change of oxidative stress and biochemical markers in the interspinous ligament tissue of patients with lumbar spondylolisthesis was compared with systemic biochemical markers and the effects of these markers on the patient's clinical and postoperative recovery process were investigated. Keywords: Lumbar spondylolisthesis, lumbar spinal stenosis, interspinous ligament, Tolal sulfydrile, AOPP (Advanced Oxidation Protein Products) , SOD (Superoxide dismutase)