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Can High-Sensitivity C-Reactive Protein Levels Predict Functional Outcome Following Epidural Steroid Injection in

Rajesh Gopireddy1, Karthick Rangasamy1, Vijay G Goni1

  • 1Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Asian Spine Journal
|December 28, 2020
PubMed
Summary

High-sensitivity C-reactive protein (hs-CRP) levels can predict epidural steroid injection (ESI) outcomes in acute lumbar disc disease. Elevated baseline hs-CRP indicates a better response to ESI for radicular pain management.

Keywords:
C-reactive proteinDisc prolapseEpidural steroid injectionInflammatory markerInterlaminarLow backacheLumbar

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Area of Science:

  • Orthopedics
  • Pain Management
  • Inflammation Biomarkers

Background:

  • Inflammatory cytokines at disc herniation sites are key pain generators in lumbar disc disease.
  • Previous studies on hs-CRP levels and lumbar pain have yielded equivocal results.
  • A clear consensus on predicting ESI benefits based on hs-CRP is lacking.

Purpose of the Study:

  • To evaluate the association between hs-CRP levels and functional outcomes (Modified Oswestry Low Back Pain Disability Questionnaire - MODY) before and after epidural steroid injection (ESI) in lumbar disc disease patients.
  • To determine if hs-CRP can predict the degree of inflammation around nerve roots.
  • To assess the predictive value of hs-CRP for ESI efficacy in lumbar disc disease.

Main Methods:

  • Prospective cohort study with 77 patients in the study group and 23 in the control group.
  • Baseline hs-CRP levels measured for all participants.
  • Study group received ESI; MODY scores assessed pre- and post-procedure; hs-CRP measured at 1 and 2 months post-injection.

Main Results:

  • Mean baseline hs-CRP was significantly higher in the study group (29.83±10.43 mg/L) than controls (10.26±2.783 mg/L).
  • In acute lumbar disc disease patients, higher baseline hs-CRP (32.19±5.126 mg/L) correlated with significant MODY score reduction at 2 months post-ESI.
  • None of the chronic lumbar disc disease cases showed significant response to ESI.

Conclusions:

  • Baseline hs-CRP levels are a valuable prognostic indicator for ESI outcomes in acute lumbar disc disease.
  • Patients with acute lumbar disc disease and radicular pain refractory to conservative treatment may benefit from ESI if hs-CRP is elevated.
  • hs-CRP can help identify patients likely to respond positively to ESI, guiding treatment decisions.