V G. Goni, P Sudesh, G Nirmal Raj, M Kataria, R Uppal
(Chandigarh, Inde)
Introduction: Inflammatory cytokines like IL-6, TNF-α, etc. produced at the site of disc herniation are considered as pain generators in patients with cervical radiculopathy. Whether high sensitive C-reactive protein (hs-CRP) assay can be used for predicting the quantum of inflammation around nerve roots is a matter of investigation. This study aimed to evaluate the association of hs-CRP level and functional outcomes measured by Neck Disability Index (NDI) before and after epidural steroid injection (ESI) in patients with cervical radiculopathy.
Methods: This was a prospective study with 45 patients in the study group and 41 participants in the control group. Baseline hs-CRP levels were measured for both. Study group patients received a single cervical ESI using interlaminar approach and were subjected to detailed pre- and post-procedure evaluation using NDI scores. For them, hs-CRP levels were measured at one, two and three months after injection.
Results: Out of 45patients, 33had acute and 12 had chronic radicular pain. 21 patients with acute pain had significant improvement while 12 had insignificant response to ESI. None of the chronic cases had a significant response. The mean baseline hs-CRP (in mg/L) among study group (12±8.281) was significantly higher than controls (2.42±1.88). The mean baseline hs-CRP among acute cases where post ESI NDI score at 3 months had significant reduction, was 12.71±7.008 and those with insignificant reduction was 5.592±3.879.
Conclusion: Baseline hs-CRP levels can be used to prognosticate the outcome following cervical ESI in patients with acute cervical radicular pain refractory to physiotherapy and analgesics.