PMID- 31659847
OWN - NLM
STAT- MEDLINE
DCOM- 20210802
LR  - 20210802
IS  - 1934-1563 (Electronic)
IS  - 1934-1482 (Linking)
VI  - 12
IP  - 7
DP  - 2020 Jul
TI  - Predicting Response to Epidural Steroid Injections for Lumbar Spinal Stenosis 
      with Biomarkers and Electromyography.
PG  - 663-670
LID - 10.1002/pmrj.12272 [doi]
AB  - BACKGROUND: Epidural steroid injections (ESIs) may be beneficial for lumbar 
      spinal stenosis (LSS) symptoms. Past studies found interferon-gamma, 
      fibronectin-aggrecan complex, and electromyography (EMG) to predict patients' 
      response to ESIs for other spinal pathologies, but no similar studies have been 
      done for LSS. OBJECTIVE: To explore the ability of biomarkers and EMG to help 
      predict outcome after ESI in LSS. DESIGN: Prospective observational cohort. 
      SETTING: The physical medicine & rehabilitation spine clinic at a tertiary care 
      center. PARTICIPANTS: Eleven patients with LSS were recruited from the spine 
      clinic at a Veterans Affairs Medical Center. INTERVENTIONS: Participants 
      underwent one interlaminar ESI. Before ESI, the following data were collected: 
      pain intensity on visual analog scale (VAS), disability via the Pain Disability 
      Questionnaire (PDQ) and LSS symptoms via the Swiss Spinal Stenosis Questionnaire 
      (SSSQ), serum high-sensitivity C-reactive protein level, standard diagnostic EMG, 
      assay of epidural lavasate (epidural saline lavage performed immediately prior to 
      ESI) and serum cytokine biomarkers indicative of inflammation. OUTCOME MEASURES: 
      Leg pain intensity (VAS), disability (PDQ), LSS symptoms (SSSQ) and satisfaction 
      (SSSQ satisfaction subscale) were assessed at 1 and 2 months following ESI. 
      Pearson correlational coefficients were calculated between independent variables 
      and outcome measures. RESULTS: Serum monocyte chemoattractant protein-1 (MCP-1) 
      level positively correlated with improvement on 2-month satisfaction. Abnormal 
      EMG finding of radiculopathy positively correlated with improvement in PDQ score 
      at 1 month. Epidural cytokine levels were not detectable in most samples, except 
      for scattered marginally elevated levels in a few cytokines such as MCP-1, RANTES 
      (Regulated on Activation, Normal T Cell Expressed and Secreted) and 
      interleukin-1b. CONCLUSIONS: This exploratory pilot study revealed that some 
      biomarkers and EMG findings indicative of inflammation and nerve root injury may 
      be predictive of improvement following ESI in patients with LSS. The results of 
      this study will be used to inform a fully powered study to further evaluate these 
      relationships in LSS patients.
CI  - (c) 2019 American Academy of Physical Medicine and Rehabilitation. This article has 
      been contributed to by US Government employees and their work is in the public 
      domain in the USA.
FAU - Lin, Chung-Kuang
AU  - Lin CK
AD  - UT Southwestern Medical Center, Dallas, TX.
FAU - Borresen, Aleksander
AU  - Borresen A
AD  - Department of Physical Medicine & Rehabilitation, University of Alabama at 
      Birmingham, Birmingham, AL.
FAU - Kroll, Mitchell
AU  - Kroll M
AD  - Dallas VA Research Corporation, VA North Texas Health Care System, Dallas, TX.
FAU - Annaswamy, Thiru M
AU  - Annaswamy TM
AUID- ORCID: 0000-0002-3969-9221
AD  - Dallas VA Research Corporation, VA North Texas Health Care System, Dallas VA 
      Medical Center, Dallas, TX.
AD  - Department of PM&R, UT Southwestern Medical Center, Dallas, TX.
LA  - eng
SI  - ClinicalTrials.gov/NCT03511053
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20191228
PL  - United States
TA  - PM R
JT  - PM & R : the journal of injury, function, and rehabilitation
JID - 101491319
RN  - 0 (Biomarkers)
RN  - 0 (Cytokines)
RN  - 0 (Steroids)
SB  - IM
MH  - Biomarkers/blood
MH  - Cytokines/blood
MH  - Electromyography
MH  - Humans
MH  - *Injections, Epidural
MH  - Lumbosacral Region
MH  - Patient Satisfaction
MH  - Pilot Projects
MH  - Prospective Studies
MH  - Rehabilitation Centers
MH  - *Spinal Stenosis/complications/drug therapy
MH  - *Steroids/therapeutic use
MH  - Tertiary Care Centers
MH  - Treatment Outcome
EDAT- 2019/10/30 06:00
MHDA- 2021/08/03 06:00
CRDT- 2019/10/30 06:00
PHST- 2019/04/23 00:00 [received]
PHST- 2019/10/21 00:00 [accepted]
PHST- 2019/10/30 06:00 [pubmed]
PHST- 2021/08/03 06:00 [medline]
PHST- 2019/10/30 06:00 [entrez]
AID - 10.1002/pmrj.12272 [doi]
PST - ppublish
SO  - PM R. 2020 Jul;12(7):663-670. doi: 10.1002/pmrj.12272. Epub 2019 Dec 28.