title: Serum hs-CRP as a useful marker for predicting the efficacy of lumbar epidural steroid injections on pain relief in patients with lumbar disc herniations.
abstract: BACKGROUND
  We examined systemic inflammatory serum markers and pain responses to image-guided lumbar epidural steroid injections (LESI) both before and after LESI in patients with lumbar disc herniations with various pathological intervertebral disc changes.
  
  
  METHODS
  Sixty male patients were scheduled for LESI every two weeks for three injections. Prior to injection therapy the following laboratory tests were performed: a complete blood count (CBC), high-sensitivity C-reactive protein (hs-CRP), and an erythrocyte sedimentation rate (ESR). Five groups of fifteen patients each were classified according to MRI observation: I) control group, II) disc protrusion, III) disc prolapse, IV) disc extrusion, and V) sequestered disc herniation. LESI were scheduled two weeks apart and were done with fluoroscopy using 40 mg of triamcinolone with 5 ml of preservative-free lidocaine. All patients returned 6 weeks following their initial injection and repeat hs-CRP assays were obtained.
  
  
  RESULTS
  No patient in this study had an abnormal CBC or ESR. No patient in the control group had an elevated hs-CRP. The percentage and number of patients in each experimental group with elevated hs-CRP levels were: II) 0% (0/15), III) 20% (3/15), IV) 80% (12/15), and V) 73% (11/15). LESI was more efficacious in the two contained disc herniation groups (II and III). It was found that the higher the hs-CRP levels prior to LESI therapy, the less improvement in pain scores following LESI.
  
  
  CONCLUSIONS
  The results of this study suggest that elevated hs-CRP levels may be useful for objectively evaluating and predicting responses to LESI in those patients with lumbar disc pathology with lower extremity radiculitis.
authors.affiliation: Pain Medicine Consultants, Little Rock, AR 72223, USA. William.Ackerman@BHSI.com
authors.forename: William E
authors.initials: WE
authors.lastname: Ackerman
authors.forename: Jun-Ming
authors.initials: JM
authors.lastname: Zhang
mesh_terms: D000328:Adult; D001416:Back Pain / Q000188:drug therapy*; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000503:physiopathology*; D007629:Kentucky; D008159:Lumbar Vertebrae / Q000503:physiopathology*; D008297:Male; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D013256:Steroids; D002097:C-Reactive Protein