title: High sensitive C-reactive protein-Effective tool in determining postoperative recovery in lumbar disc disease.
abstract: BACKGROUND
  It is common in medical practice to see patients having persistent pain and radiculopathy even after undergoing discectomy surgery. Inflammatory cytokines, such as interleukins are produced at the site of disc herniation and are now considered responsible for the pain perceived by the patient. This study has used high sensitive C-reactive protein (HSCRP) assay for predicting inflammation around the nerve roots on very same principle, which has used HSCRP for predicting coronary artery diseases in current clinical practice. Thus, purpose of this study is to test whether HSCRP can stand as an objective tool to predict postoperative recovery in patients undergoing lumbar discectomy. That is, to study association between preoperative HSCRP blood level and postoperative recovery with the help of modified Oswestry Back Disability Score.
  
  
  METHODS
  A study group consisting of 50 cases of established lumbar disc disease and control group of 50 normal subjects, matched with the study group. Both the study and control groups were subjected to detailed evaluation with the help of modified Oswestry Low Back Pain Scale both pre and postoperatively at 3 months, 6 months and 1-year. The preoperative blood samples were analyzed to assess the HSCRP concentration. All the cases underwent surgery over a period of 1-year by the same surgeon.
  
  
  RESULTS
  The level of HSCRP in the study group was between 0.050- and 0.710 mg/dL and in the control group, 0.005-0.020 mg/dL. There was highly significant positive correlation between preoperative HSCRP level and postoperative score at P < 0.005. Cases with HSCRP level in the range of 0.1820 ± 0.079 mg/dL, showed better recovery (score improved > 10 points), while those with HSCRP level in the range of 0.470 ± 0.163 mg/dL, showed poor recovery (score improved < 10 points).
  
  
  CONCLUSIONS
  HSCRP will serve as a good supplementary prognostic marker for operative decision making in borderline and troublesome cases of lumbar disc disease.
authors.affiliation: Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India.
authors.forename: Tushar Narayan
authors.initials: TN
authors.lastname: Rathod
authors.affiliation: Department of Orthopaedics, B.J. Medical College and Sasoon Hospital, Pune, Maharashtra, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Chandanwale
authors.affiliation: Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India.
authors.forename: Kiran M
authors.initials: KM
authors.lastname: Ladkat
authors.affiliation: Department of Medicine, Grant Medical College and Sir JJ Group of Hospital, Mumbai, India.
authors.forename: Shital
authors.initials: S
authors.lastname: Chavan
authors.affiliation: Department of Paediatrics, M.G.M. Medical College, Navi Mumbai, India.
authors.forename: Arvind
authors.initials: A
authors.lastname: Chavan
authors.affiliation: Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India.
authors.forename: Pradeep B
authors.initials: PB
authors.lastname: Bhosale
keywords: Lumbar; Lumbar disc disease; blood proteins; disc; discectomy; herniated; high sensitive C-reactive protein; sciatica