DIFFERENTIAL TRENDS OF HIGH SENSITIVE C-REACTIVE PROTEIN AND FUNCTIONAL OUTCOME AFTER ADMINISTRATION OF EPIDURAL STEROIDS IN ACUTE AND CHRONIC CASES OF CERVICAL RADICULOPATHY

Abhinay Sharma; Vijay G. Goni; Y.K. Batra; Chetana Vaishnavi; Pebam Sudesh; Ambuj Shandil

Volume : VIII, Issue : VIII, August - 2019

DIFFERENTIAL TRENDS OF HIGH SENSITIVE C-REACTIVE PROTEIN AND FUNCTIONAL OUTCOME AFTER ADMINISTRATION OF EPIDURAL STEROIDS IN ACUTE AND CHRONIC CASES OF CERVICAL RADICULOPATHY

Abhinay Sharma, Vijay G. Goni, Y. K. Batra, Chetana Vaishnavi, Pebam Sudesh, Ambuj Shandil

Abstract :

Background and objectives : Cervical Epidural steroid injections (CESI) have now been used for a number of years and have shown intense growth in the treatment of radicular pain after failed conservative treatment with oral medication, physical therapy and lifestyle modifications. In their 2010 Guideline for The Treatment of Cervical Radicular Pain, the World Institute of Pain issued a positive recommendation for interlaminar cervical epidural steroid injections for the treatment of cervical radicular pain.(1) Traditionally radicular pain has been thought to be caused due to the mechanical compression of nerve roots by the herniated nucleus pulposus (HNP). However it has now increasingly become evident that radicular pain also involves an underlying inflammatory component. Prostaglandin E2, tumor necrosis factor -α (TNF-α), interleukin-6 (IL-6), nitric oxide (NO), and matrix metalloproteinases are released by the herniated cervical interverteal discs.(2-4) So it is not only the mechanical compression of nerve roots, but also the inflammation around the nerve roots which is responsible for the pain perceived by the patient. In this study we have used high sensitive C- reactive protein (hsCRP) assay for prediction of inflammation around nerve roots. This ultrasensitive assay is normally capable of measuring serum hsCRP at a concentration of 0.0095 mg/L using ultrasensitive latex enhanced immunoassay on the BN II nephelometer(5) or by using ELISA (Enzyme linked Immunosorbent Assay). We have used the visual analogue scale (VAS) as a measure of pain and functional outcome after CESI. Methods: This study was a prospective study design. A single cervical epidural steroid injection was given to all cases in our study after documentation of the baseline hsCRP levels and VAS scores. All CESIs were administered by a single anesthetist through the interlaminar approach. Blood hsCRP levels and VAS scores were reassessed at the first month, second month and third month of follow up. Results : The blood hsCRP values at presentation or the baseline hsCRP level was significantly elevated in cases of cervical radiculopathy as compared to apparently normal controls without cervical radiculopathy. There was an increase in baseline hsCRP values at presentation in both acute as well as chronic cases of cervical radiculopathy . However the increase in chronic cases was considerably more significant than the increase in acute cases.