DOI: 10.54005/geneltip.1715434 ISSN: 2602-3741

Can Systemic Inflammatory Mediators Predict the Pain Response to Cervical Epidural Steroid Injection?

Hamit Göksu, Samet Sancar Kaya
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Aim: We aimed to assess systemic inflammatory mediators (SIMs) such as neutrophile-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), monocyte-to-eosinophile ratio (MER), and systemic immune-inflammatory index (SII) in terms of meaningful pain relief after cervical epidural steroid injection (CESI) in patients with cervical disk herniations (CDH).Materials and Methods: Patients between 20-60 years with CDH and radicular neck pain lasting less than 3 months, no additional pathology on imaging, persistent pain despite medical treatment, and those with complete blood counts, sedimentation, and C-reactive protein values before CESI were included in the study. The visual analog scale (VAS) scores recorded before and one month after CESI were obtained from the hospital database. Patients who responded to treatment, defined as a 50% reduction in VAS score (meaningful pain relief), and those who did not respond were grouped as responders and non-responders. SIMs, including NLR, PLR, LMR, MER, and SII, were compared between patient groups.Results: Sixty-five percent of the patients formed the responder group to CESI, and 15 patients formed the non-responder group. The groups were similar in age, gender, pain duration, and pre-treatment VAS scores (p>0.05). NLR and SII levels were higher in the non-responder group (p=0.035 and p=0.028). Using ROC analysis, the cut-off value of NLR for the absence of meaningful pain relief after CESI was calculated as 1.8 with 68.0% sensitivity, 73.3% specificity, and a likelihood ratio (LR) of 2.55 (p=0.035), and the cut-off value of SII was calculated as 448.4 with 72.0% sensitivity, 66.7% specificity, and a LR of 2.1 (p=0.028).Conclusions: Higher NLR and SII values were associated with a poorer pain response after CESI. Further prospective studies with larger sample sizes, including repeated measurements of SIMs, could further elucidate the effect of SIMs on pain relief after CESI.

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