Abstract
BackgroundAn understanding of the clinical features of inflammation in low back pain with or without leg symptoms may allow targeted evaluations of anti-inflammatory treatment in randomised-controlled-trials and clinical practice.PurposeThis study evaluated the diagnostic accuracy of clinical features to predict the presence/absence of histologically confirmed inflammation in herniated disc specimens removed at surgery in patients with lumbar disc herniation and associated radiculopathy (DHR).Study designCohort Study.MethodsDisc material from patients with DHR undergoing lumbar discectomy was sampled and underwent histological/immunohistochemistry analyses. Control discs were sampled from patients undergoing surgical correction for scoliosis. Baseline assessment comprising sociodemographic factors, subjective examination, physical examination and psychosocial screening was conducted and a range of potential clinical predictors of inflammation developed based on the existing literature. Multi-variate analysis was undertaken to determine diagnostic accuracy.ResultsForty patients with DHR and three control patients were recruited. None of the control discs had evidence of inflammation compared to 28% of patients with DHR. Predictors of the presence of histologically confirmed inflammation included back pain < 5/10, symptoms worse the next day after injury, lumbar flexion range between 0 and 30° and a positive clinical inflammation score (at least 3 of: constant symptoms, morning pain/stiffness greater than 60-min, short walking not easing symptoms and significant night symptoms). The model achieved a sensitivity of 90.9%, a specificity of 92.9%, and a predictive accuracy of 92.3%.ConclusionIn a sample of patients with lumbar DHR a combination of clinical features predicted the presence or absence of histologically confirmed inflammation.Clinical relevanceThese clinical features may enable targeted anti-inflammatory treatment in future RCTs and in clinical practice.
Highlights
The degenerated lumbar intervertebral disc is a potential contributor to low back pain with or without leg symptoms (LBP) [4]
Evidence suggests that inflammatory processes are a potential treatment target for people with Low back pain (LBP)
A method of detecting patients with LBP and associated inflammation is likely required so their treatment can be tailored appropriately
Summary
The degenerated lumbar intervertebral disc is a potential contributor to low back pain with or without leg symptoms (LBP) [4]. The high serum tumour necrosis factor in acute LBP was recently demonstrated to be a predictor for poor recovery of pain and activity limitation at 6-months [26] These findings indicate that inflammatory processes are a plausible treatment target for people with LBP treated in clinical practice or clinical trials. In these trials, if a substantial proportion of the sample do not have an inflammatory component to their LBP, any effect of antiinflammatory treatment on the sample overall has the potential to be diluted. Purpose: This study evaluated the diagnostic accuracy of clinical features to predict the presence/absence of histologically confirmed inflammation in herniated disc specimens removed at surgery in patients with lumbar disc herniation and associated radiculopathy (DHR)
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