What is known about the subject
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Evidence suggests that inflammatory processes are a potential treatment target for people with LBP.
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There is limited evidence for the effectiveness of anti-inflammatory treatment in LBP.
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A method of detecting patients with LBP and associated inflammation is likely required so their treatment can be tailored appropriately.
What this study adds to existing knowledge
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A composite clinical inflammation score predicted histological inflammation in discs from patients undergoing lumbar discectomy.
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Control disc specimens had no histological evidence of inflammation.
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These clinical features may enable targeted anti-inflammatory treatment in future RCTs and in clinical practice.
Introduction
Materials and methods
Study population
Tissue collecting procedure
Histological analysis
Immunohistochemistry analysis
Potential clinical features of inflammation
Statistical analysis
Results
Characteristic | Mean (SD) or N (%) |
---|---|
Age (years) | 43.5 (14.7) |
Gender (Male) | 31 (77.5%) |
Smoker | 8 (20.0%) |
Compensation claim | 10 (25.0%) |
Back pain (VAS /10) | 5.3 (2.1) |
Leg pain (VAS /10) | 6.3 (2.3) |
Pain or paraesthesia below knee | 37 (92.5%) |
First episode | 17 (42.5%) |
Duration of symptoms (current episode) | |
1 week – 1 month | 8 (20.0%) |
2–3 months | 8 (20.0%) |
4–6 months | 13 (32.5%) |
7–12 months | 2 (5.0%) |
> 12 months | 9 (22.5%) |
Activity limitation (Oswestry) | 40.1 (15.8) |
Örebro score | 115.7 (22.8) |
MRI findings | |
Herniation type | |
Bulge or normal | 1 (2.5%) |
Protrusion | 16 (40.0%) |
Extrusion | 21 (52.5%) |
Sequestration | 1 (2.5%) |
Nerve root involvement | |
None | 0 (0.0%) |
Contact | 2 (5.0%) |
Displacement | 6 (15%) |
Compression | 31 (77.5%) |
Annular tear | |
None | 4 (10.3%) |
Mild tear | 23 (59.0%) |
Severe tear | 12 (30.8%) |
Physical examination findings: | |
Ipsilateral SLR: mean (SD) degrees | 50.2 (17.8) |
Contralateral SLR: mean (SD) degrees | 69.5 (15.8) |
Neurological deficit (affected side) | |
Reflex deficit | 28 (70.0%) |
Myotomal deficit | 16 (40.0%) |
Dermatomal deficit | 31 (77.5%) |
At least one neurological deficit | 38 (95.0%) |
Clinical features predicting histologically confirmed inflammation
B (intercept) | p-value | Exp(B) (odds ratio) | Lower 95%CI for Exp(B) | Upper 95%CI for Exp(B) | |
---|---|---|---|---|---|
Model 1: (all significant univariate factors included) | |||||
Clinical inflammation score >/=3 | 2.7 | 0.05 | 15.2 | 1.0 | 233.6 |
Back pain < 5/10 | 2.2 | 0.19 | 9.1 | 0.3 | 258.0 |
Can sit with a firm backrest > 30 min | 0.2 | 0.90 | 1.2 | 0.1 | 24.3 |
Worse the next day after injury | 1.2 | 0.35 | 3.2 | 0.3 | 36.2 |
Flexion range of motion 0–30° | 1.1 | 0.37 | 3.1 | 0.3 | 38.2 |
MRI - disc extrusion | 1.0 | 0.47 | 2.7 | 0.2 | 40.4 |
Intercept | −4.9 | 0.00 | 0.0 | ||
Model 2: (Final model with only significant predictors remaining) | |||||
Clinical inflammation score >/=3 | 2.8 | 0.03 | 16.5 | 1.4 | 195.3 |
Back pain < 5/10 | 3.1 | 0.01 | 23.1 | 2.4 | 224.6 |
Constant | −3.1 | 0.00 | 0.0 | ||
Model 3: Best balance of model parsimony and performance | |||||
Clinical inflammation score >/=3 | 2.6 | 0.04 | 12.8 | 1.1 | 154.7 |
Back pain < 5/10 | 2.8 | 0.02 | 16.4 | 1.6 | 172.7 |
Worse the next day after injury | 1.4 | 0.25 | 3.9 | 0.4 | 39.2 |
Flexion range of motion 0–30° | 1.4 | 0.24 | 4.0 | 0.4 | 40.9 |
Constant | −4.8 | 0.00 | 0.0 |
Histology negative for inflammation | Histology positive for inflammation | |||||||||||
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Model | N | Predicted negative for inflammation | Predicted positive for inflammation | Predicted negative for inflammation | Predicted positive for inflammation | Sensitivity | Specificity | % correctly predicted | LR+ | LR- | Diagnostic Odds Ratio | R-square (Cox & Snell) |
Model 1 | 37 | 24 | 2 | 1 | 10 | 90.9% | 92.3% | 91.9% | 11.8 | 0.1 | 120.0 | 0.42 |
Model 2 | 40 | 24 | 5 | 3 | 8 | 72.7% | 82.8% | 80.0% | 4.2 | 0.3 | 12.8 | 0.36 |
Model 3 | 39 | 26 | 2 | 1 | 10 | 90.9% | 92.9% | 92.3% | 12.7 | 0.1 | 130.0 | 0.42 |