The effect of vitamin D3 combined with traction on the treatment of lumbar disc herniation.

Evaluación de la eficacia clínica de la vitamina D3 combinada con la tracción en pacientes con hernia de disco lumbar.

• Yina Yin Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Changxing Branch, Shanghai, China. https://orcid.org/0009-0007-1907-5773
• Jiaojiao Huang Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Changxing Branch, Shanghai, China. https://orcid.org/0009-0004-5828-156X

DOI: https://doi.org/10.54817/IC.v67n2a02

Palabras clave: Vitamina D, Hernia de disco intervertebral, Tracción, Inflamación, Dolor, Rehabilitación

Resumen

Este estudio se centró en evaluar la eficacia clínica de la terapia combinada con vitamina D₃ y tracción en pacientes con hernia de disco lumbar. Se incluyeron 112 pacientes que recibieron tratamiento de rehabilitación conservador en nuestro hospital entre enero de 2021 y diciembre de 2023. Los pacientes fueron asignados aleatoriamente a dos grupos: uno recibió únicamente tratamiento de tracción y el otro, tracción más tratamiento oral con vitamina D₃  durante 4 semanas. Se compararon la eficacia clínica y la calidad de vida entre ambos grupos. Los resultados mostraron que ambos tratamientos mejoraron el nivel de dolor y la función lumbar, aunque la combinación de vitamina D₃ con tracción produjo una mejora significativamente mayor. Los marcadores de inflamación y dolor disminuyeron notablemente, y los niveles de 25(OH)D₃ aumentaron en ambos grupos, con una mejoría mayor en el grupo combinado. Además, el estado de ánimo y la calidad de vida mejoraron de forma más significativa en el grupo de tratamiento combinado. No se observaron diferencias estadísticamente significativas entre los indicadores de prueba al mes de seguimiento y al de tratamiento. En conclusión, la combinación de vitamina D₃ y terapia de tracción puede mejorar eficazmente los resultados clínicos a corto plazo y la calidad de vida de los pacientes con hernia discal lumbar.

Citas

An IHS, Thonar EJ, Masuda K. Biological repair of intervertebral disc. Spine (Phila Pa 1976). 2003;28(15 Suppl):886-92. https://doi.org/10.1097/01.BRS.0000076904.99434.40.

Chen Z, Cao P, Zhou Z, Yuan Y, Jiao Y, Zheng Y. Overview: the role of Propionibacterium acnes in nonpyogenic intervertebral dises. Int Orthop. 2016;40(6):1291-1298. https://doi.org/10.1007/s00264-016-3115-5.

Urquhart DM, Zheng Y, Cheng AC, Rosenfeld JV, Chan P, Liew S, et al. Could low grade bacterial infection contribute to low back pain? A systematic review. BMC Med. 2015:13:13. https://doi.org/10.1186/s12916-015-0267-x.

Fjeld OR, Grøvle L, Helgeland J, Småstuen MC, Solberg TK, Zwart JA, et al. Complications, reoperations, readmissions, and length of hospital stay in 34639 surgical cases of lumbar disc herniation. Bone Joint J. 2019;101-B(4):470-477. https://doi.org/10.1302/0301-620X.101B4.BJJ-2018-1184.R1.

Cimmino MA, Ferrone C, Cutolo M. Epidemiology of chronic musculoskeletal pain. Best Pract Res Clin Rheumatol. 2011;25(2):173-183. https://doi.org/10.1016/j.berh.2010.01.012.

Amin RM, Andrade NS, Neuman BJ. Lumbar Disc Herniation. Curr Rev Musculoskelet Med. 2017;10(4):507-516. https://doi.org/10.1007/s12178-017-9441-4.

Kreiner DS, Hwang SW, Easa JE, Resnick DK, Baisden JL, Bess S, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14(1):180-191. https://doi.org/10.1016/j.spinee.2013.08.003.

Chou R, Loeser JD, Owens DK, Rosenquist RW, Atlas SJ, Baisden J, et al. Interventional therapies, surgery, and interdisciplinary rehabilitation for low back pain: an evidence-based clinical practice guideline from the American Pain Society. Spine (Phila Pa 1976). 2009;34(10):1066-1077. https://doi.org/10.1097/BRS.06013e3181a1390d.

Vanti C, Turone L, Panizzolo A, Guccione AA, Bertozzi L, Pillastrini P. Vertical traction for lumbar radiculopathy: a systematic review. Arch Physiother. 2021;11(1):7. https://doi.org/10.1186/s40945-021-00102-5.

Kumari A, Quddus N, Meena PR, Alghadir AH, Khan M. Effects of One-Fifth, One-Third, and One-Half of the Bodyweight Lumbar Traction on the Straight Leg Raise Test and Pain in Prolapsed Intervertebral Disc Patients: A Randomized Controlled Trial. Biomed Res Int. 2021 2021:2561502. https://doi.org/10.1155/2021/2561502.

Tadano M, Tanabe H, Arai S, Fujino K, Doi T, Akai M. Lumbar mechanical traction: a biomechanical assessment of change at the lumbar spine. BMC Musculoskelet Disord. 2019;20(1): 155. https://doi.org/10.1186/s12891-019-2545-9.

Cheng YIH, Hsu CY, Lin YN. The effect of mechanical traction on low back pain in patients with herniated intervertebral disks: a systematic review and meta-analysis. Clin Rehabil. 2020 34(1):13-22. https://doi.org/10.1177/0269215519872528.

Gaydarski L, Sirakov I, Uzunov K, Chervenkov M, Ivanova T, Gergova R, et al. A Case-Control Study of the FokI Polymorphism of the Vitamin D Receptor Gene in Bulgarians with Lumbar Disc Herniation. Cureus. 2023;15(9):e45628. https://doi.org/10.7759/cureus.45628.

Kawaguchi Y, Kanamori M, Ishihara H, Ohmori K, Matsui H, Kimura T. The association of lumbar disc disease with vitamin-D receptor gene polymorphism. J Bone Joint Surg Am. 2002;84(11):2022-2028, https://doi.org/10.2106/00004623-200211000-00018.

Withanage ND, Perera S, Peiris H, Athiththan IV. Serum 25-hydroxyvitamin D, serum calcium and vitamin D receptor (VDR) polymorphisms in a selected population with lumbar disc herniation A case control study. PLoS One. 2018;13(10):e0205841. https://doi.org/10.1371/journal.pone.0205841.

Garcion E, Wion-Barbot N, Montero-Menei CN, Berger F, Wion D. New clues about vitamin D functions in the nervous system. Trends Endocrinol Metab. 2002;13(3):100-105. https://doi.org/10.1016/s1043-2760(01)00547-1.
Myers RR, Campana WM, Shubayev VI. The role of neuroinflammation in neuropathic pain: mechanisms and therapeutic targets. Drug Discov Today. 2006;11(1-2):8-20. https://doi.org/10.1016/S1359-6446(05)03637-8.

Xu J, Hu Y. Clinical Features and Efficacy Analysis of Redundant Nerve Roots. Front Surg. 2021;8:628928. https://doi.org/10.3389/fsurg.2021.628928.

Lu Z, Ding A, Yu Q, Wang H, Ma L. Effect of the preoperative assessment of the anteroposterior diameters of the spinal canal and dural area on the efficacy of oblique lumbar interbody fusion in patients with lumbar spinal stenosis. J Orthop Surg Res. 2023;18(1):440. https://doi.org/10.1186/13018-023-03913-3.

Eijsvogels TMH, Maessen MFH, Bakker EA, Meindersma EP, van Gorp N, Pijnenburg N, et al. Association of Cardiac Rehabilitation with All-Cause Mortality Among Patients with Cardiovascular Disease in the Netherlands. JAMA Netw Open. 2020;3(7):e2011686. https://doi.org/10.1001/jamanetworkopen.2020.11686.

Cosamalón-Gan I, Cosamalón-Gan T, Mattos-Piaggio G, Villar-Suárez V, García-Cosamalón J, Vega-Álvarez JA. Inflammation in the intervertebral disc herniation. Neurocirugia (Engl Ed). 2021;32(1):21-35. https://doi.org/10.1016/j.neucir.2020.01.001.

Ozturk B, Gunduz OH, Ozoran K, Bostanoglu S. Effect of continuous lumbar traction on the size of herniated disc material in lumbar disc herniation. Rheumatol Int. 2006;26(7):622-626. https://doi.org/10.1007/s00296-005-0035-х.

Yang Q, Liu Y, Guan Y, Zhan X, Xiao Z, Jiang H, et al. Vitamin D Receptor gene polymorphisms and plasma levels are associated with lumbar disc degeneration. Sci Rep. 2019 9(1):7829. https://doi.org/10.1038/s41598-019-44373-2.

Sedighi M, Haghnegahdar A. Role of vitamin $D_{3}$ in treatment of lumbar disc herniation-pain and sensory aspects: study protocol for a randomized controlled trial. Trials. 2014;15:373. https://doi.org/10.1186/1745-6215-15-373.

Martirosyan NL, Patel AA, Carotenuto A, Kalani MY, Belykh E, Walker CT, et al. Genetic Alterations in Intervertebral Disc Disease. Front Surg. 2016;3:59. https://doi.org/10.3389/fsurg.2016.00059.

Kim H, Hong JY, Lee J, Jeon WJ, Ha IH. IL-1β promotes disc degeneration and inflammation through direct injection of intervertebral disc in a rat lumbar disc herniation model. Spine J. 2021;21(6):1031-1041. https://doi.org/10.1016/j.spinee.2021.01.014.

Andrade P, Hoogland G, Garcia MA, Steinbusch HW, Daemen MA, Visser-Vandewalle V. Elevated IL-1β and IL-6 levels in lumbar herniated discs in patients with sciatic pain. Eur Spine J. 2013;22(4):714-720. https://doi.org/10.1007/s00586-012-2502- .

Huang K, Hsu Y, Chen W, Tsai H, Yan J, Wang J, et al. The roles of IL-19 and IL-20 in the inflammation of degenerative lumbar spondylolisthesis. J Inflamm (Lond). 2018;15:19. https://doi.org/10.1186/s12950-018-0195-6

Zhang X, Wang X, Gao L, Yang B, Wang Y, Niu K, et al. TNF-a induces methylglyoxal accumulation in lumbar herniated disc of patients with radicular pain. Front Behav Neurosci. 2021;15:760547. https://doi.org/10.3389/fnbeh.2021.760547.

Sella EJ. Noncompressive spinal radiculitis. Orthop Rev. 1992;21(7):827-832. PMID: 1501920.

Liu J, Ye YJ, Liu SM, Liu S. [Analysis of the effect of midazolam on pain in a rat model of lumbar disc herniation based on the p38 MAPK signaling pathway]. Zhongguo Gu Shang. 2023;36(1):55-60. Chinese. https://doi.org/10.12200/j.issn.1003-0034.2023.01.010.

Kawakami M, Matsumoto T, Kuribayashi K, Tamaki T. mRNA expression of interleukins, phospholipase $A_{2}$, and nitric oxide synthase in the nerve root and dorsal root ganglion induced by autologous nucleus pulposus in the rat. J Orthop Res. 1999;17(6):941-946. https://doi.org/10.1002/jor.1100170620.

Moalem G, Tracey DJ. Immune and inflammatory mechanisms in neuropathic pain. Brain Res Rev. 2006;51(2):240-264. https://doi.org/10.1016/j.brainresrev.2005.11.004.

Du P, Zhang Q, Zhang Y. The role of IL-6, IL-10, and $PGE_{2}$ in the treatment of intervertebral disc herniation by dual-channel endoscopic lumbar discectomy. Cell Mol Biol (Noisy-le-grand). 2022;67(5):188-195. https://doi.org/10.14715/cmb/2021.67.5.26.

Cheda A, Nowosielska EM, Gebicki J, Marcinek A, Chlopicki S, Janiak MK. A derivative of vitamin B3 applied several days after exposure reduces lethality of severely irradiated mice. Sci Rep. 2021;11(1):7922. https://doi.org/10.1038/s41598-021-86870-3.

Zung WW. A self-rating depression scale. Arch Gen Psychiatry. 1965;12(1):63-70. https://doi.org/10.1001/archpsyc.1965.01720310065008.

Patrick DL, Deyo RA, Atlas SJ, Singer DE, Chapin A, Keller RB. Assessing health-related quality of life in patients with sciatica. Spine. 1995;20(17):1899-1908. https://doi.org/10.1097/00007632-199509000-00011.