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

Abstract

Study Design: Prospective cohort study.Purpose: Inflammatory cytokines produced at the site of disc herniation are considered as pain generators in patients with lumbar disc disease. Whether a high-sensitivity C-reactive protein (hs-CRP) assay can be used in order to predict the quantum of inflamma-tion surrounding nerve roots is a matter of investigation. This study aimed to evaluate the association of hs-CRP level and functional outcomes measured by the Modified Oswestry Low Back Pain Disability Questionnaire (MODY) before and after epidural steroid injec-tion (ESI) in patients with lumbar disc disease.Overview of Literature: Although many studies examining the role of hs-CRP levels and lumbar pain have been published previ-ously, the results are equivocal, and there is no clear consensus regarding which patients will benefit from an ESI.Methods: This was a prospective study, with 77 patients in the study group and 23 participants in the control group. Baseline hs-CRP levels were obtained for both groups. Study group patients received a single ESI and were subjected to detailed pre and post-procedure evaluation using MODY scores. For this group, hs-CRP levels were measured at 1 and 2 months after injection.Results: Out of 77 patients, 52 had acute and 25 had chronic low back pain. Thirty-six patients with acute pain obtained significant improvement, while 16 had an insignificant response to the ESI. None of the chronic cases had a significant response. The mean baseline hs-CRP (mg/L) among the study group (29.83±10.43) was significantly higher than for the controls (10.26±2.783). The base-line hs-CRP among acute cases, where post ESI MODY score at 2 months had significant reduction, was 32.19±5.126, and those with insignificant reduction was 18.13±7.949 (p <0.001).Conclusions: Baseline hs-CRP levels can be used to prognosticate the outcome following ESI in patients with acute lumbar disc dis-ease, with radicular pain refractory to physiotherapy and analgesics.