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Fibronectin and Aggrecan Predict Epidural Outcome in HNP

Discussion in 'Pain Medicine' started by 101N, Aug 10, 2011.

  1. 101N

    101N Membership Revoked
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    Spine;15 August 2011 - Volume 36 - Issue 18 - p 1464–1469

    Outcome of Lumbar Epidural Steroid Injection Is Predicted by Assay of a Complex of Fibronectin and Aggrecan From Epidural Lavage

    Golish, S. Raymond MD, PhD*; Hanna, Lewis S. PhD†; Bowser, Robert P. PhD‡; Montesano, Pasquale X. MD§; Carragee, Eugene J. MD*; Scuderi, Gaetano J. MD*

    Abstract
    Study Design. A single-center, prospective, consecutive case series of patients undergoing epidural lavage before the treatment of radiculopathy due to lumbar disc herniation.

    Objective. To determine whether a novel complex of fibronectin and aggrecan predicts clinical response to epidural steroid injection (ESI) for the indication of radiculopathy from lumbar herniated nucleus pulposus (HNP).

    Summary of Background Data. ESI for lumbar radiculopathy due to HNP is widely used despite variable effectiveness for this indication. With increased attention aimed at cost containment, it would be beneficial to identify those in whom ESI may be helpful. There are currently no accurate diagnostic tests to predict response to ESI in back pain and sciatica syndromes. We have previously investigated biomarkers of disc degeneration associated with radiculopathy.

    Methods. We embarked to determine whether a molecular complex of fibronectin and aggrecan predicts clinical response to ESI for the indication of radiculopathy from HNP. This prospective study was conducted at a single center and included 26 patients with radiculopathic pain and magnetic resonance imaging positive for HNP, who elected ESI. Epidural lavage with physiologic saline was performed immediately before ESI. The lavage fluid was assayed for the fibronectin–aggrecan complex (FAC) by using a heterogeneous sandwich enzyme-linked immunosorbent assay. The results were compared with the interval improvement in the physical component summary (PCS) score of the Medical Outcomes Study Short Form-36 instrument (SF-36) after injection compared with baseline.

    Results. The mean improvement from baseline PCS in patients with the FAC was 22.9 (SD, 12.4) and without the complex was 0.64 (SD, 3.97; P < 0.001). Differences in total SF-36 improvement were also highly significant (P < 0.001). The presence of the FAC predicts a clinically significant increase in PCS after lumbar ESI by receiver-operating-characteristic analysis (area under the curve = 0.97; P < 0.001). There was no significant difference in age (P = 0.25), sex (P = 0.84), laterality (P = 0.06), lumbar spinal level (P = 0.75), or payer type (worker's compensation vs. private insurance; P = 0.90) between groups with and without the marker.

    Conclusion. A molecular complex of fibronectin and aggrecan predicts response to lumbar ESI for radiculopathy with HNP. The biomarker is accurate, objective, and not affected by demographic or psychosocial variables in this series.
     
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  2. lobelsteve

    lobelsteve SDN Lifetime Donor
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    I can't fathom a clinical utility or means to an end for this study.

    Is gene selling a new test?


    So who cares about epidural lavage?
     
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  3. epidural man

    epidural man ASA Member
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    Completely agree.

    Here is another way to predict if an ESI will work. AFter you do the injection, call them in 5 to 7 days. I know it isn't as sexy, but a lot cheaper.
     
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  4. Mister Mxyzptlk

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    Agree. If you're in the epidural space already, forget the lavage and just drop in the steroids and you'll know for sure in a few days.
     
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  5. lonelobo

    lonelobo PAIN DOC
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    Where does the Carragee Defender on the forum stand on this study?


    If he supports this one, he has to be a Mole and my vote is that he/she should be Drawn and Quartered
     
  6. OP
    OP
    101N

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    I absolutely support the study. If there were a SIMPLE & PRACTICAL way to determine in advance who might be more likely to benefit from a therapy I would find that useful information. I don't want to perform epidurals that don't help people. That said, nor do I want people to have spine surgery that wont help them either.

    I don't think the lead author intends to use epidural lavage as the principle assay over the long term. My guess is that they are working on a cheap serum marker.
     
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  7. bedrock

    bedrock Member
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    If there is a reliable serum marker, sure. If you
    Have to enter epidural space just do the bloody ESI.
    Bet ya $100, they'll never find a reliable serum marker.
     
  8. lonelobo

    lonelobo PAIN DOC
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    Exactly

    yes my suspicions were right he is a mole...get the horses ready
     
  9. facets

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    Don't forget the pikes to put his head on outside the city gates
     
  10. bedrock

    bedrock Member
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    You're referring to 101n?
     
  11. facets

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    medival history
     
  12. lonelobo

    lonelobo PAIN DOC
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    yep
     

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