Prognostic Usefulness of High Sensitivity C-Reactive Protein for Transforaminal Epidural Steroid Injection in Patients with Radicular Pain

Abstract

There are several types of lumbar stenosis, such as central, lateral recess, foraminal. The symptoms of lumbar stenosis are neurogenic claudication, numbness, tingling, etc. The treatment modality is medication, physical therapy, intervention, and surgery. The epidural steroid injection has been used for treatment of low back pain/radiculopathy. However, we could not predict what percent had pain relief after epidural steroid injection. The purpose of this study was to evaluate the usefulness of high sensitivity C-reactive protein (hsCRP) as a marker for predicting the efficacy of lumbar transforaminal epidural steroid injection. A total of 55 patients with lumbar stenosis underwent lumbar transforaminal epidural steroid injection under fluoroscopic guidance. Prior to injection, all patients were examined and their visual analog scale (VAS) score and hsCRP score were recorded. They returned 4 weeks following their initial injection and repeat hsCRP, and VAS sores were obtained. The average pretreatment hsCRP and VAS score for all 55 patients were 3.2±4.3 mg/L and 8.1±1.1, respectively. Forty-two of 55 patients had 1.6 mg/L of hsCRP. After procedure, the VAS decreased from 8.0±1.1 to 2.5±1.1. In contrast, the averages of hsCRP and VAS scores of 13 patients were 9.4±3.7 mg/L and 8.2±0.9, respectively, at baseline, which decreased to 1.2±0.9 mg/L and 2.5±0.8 at 4 weeks later. At posttreatment, the VAS score difference between the two groups was not statistically significant. There was no correlation between hsCRP and VAS score (P=0.426). The results suggest that there was no correlation between pretreat hsCRP and posttreat VAS. Therefore, hsCRP may not be useful as predictor of response to TFESI in patients with spinal stenosis.