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. 2022 May 1;35(4):137-143.
doi: 10.1097/BSD.0000000000001318. Epub 2022 Mar 30.

Do Inflammatory Cytokines Affect Patient Outcomes After ACDF?

Brian A Karamian  1   2 , Hannah A Levy  2 , Payton Boere  2 , Goutham R Yalla  2 , Jose A Canseco  1   2 , Michael Chang  1   2 , Srikanth N Divi  1   2 , Taolin Fang  2 , Paul W Millhouse  2 , Mayan Lendner  2 , Alan S Hilibrand  1   2 , Alexander R Vaccaro  1   2 , Christopher K Kepler  1   2 , Dessislava Z Markova  2 , Gregory D Schroeder  1   2
Affiliations

Do Inflammatory Cytokines Affect Patient Outcomes After ACDF?

Brian A Karamian et al. Clin Spine Surg. .

Abstract

Study design: Prospective cohort study.

Objective: The aim was to determine the relationship between serum inflammatory mediators, preoperative cervical spine disease severity, and clinical outcomes after anterior cervical discectomy and fusion (ACDF).

Summary of background data: Given the role of the inflammatory cascade in spinal degenerative disease, it has been hypothesized that inflammatory markers may serve as a predictor of patient outcomes after surgery.

Materials and methods: All patients over age 18 who underwent ACDF for cervical spondylosis with associated radiculopathy and/or myelopathy between 2015 and 2017 from a single institution were prospectively recruited. Preoperative serum inflammatory markers including interleukin (IL)-6, IL-8, tumor necrosis factor-α, high-mobility group box-1 (HMGB1), and white blood cells were measured and correlated to patient demographics, surgical characteristics, duration of symptoms, previous opioid use, and preoperative and 1-year postoperative patient-reported outcomes measures (PROMs) including the neck disability index (NDI), visual analog scale neck pain, visual analog scale arm pain, and Physical and Mental Component Scores of the Short Form-12 (PCS and MCS, respectively) using spearman's rho coefficient.

Results: A total of 77 patients were enrolled with follow-up PROMs available for 62% (n=48) of patients at a minimum of 1-year after ACDF. The absolute concentrations of IL-6 and tumor necrosis factor-α were found to be weakly correlated with one another (ρ=0.479). Preoperative symptoms lasting <1-year were weakly correlated with elevation in HMGB1 (ρ=0.421). All other patient demographics exhibited negligible correlation with the preoperative inflammatory markers. Lower preoperative PCS (ρ=0.355) and higher preoperative NDI (ρ=0.336) were weakly correlated with elevated HMGB1. Lower MCS (ρ=0.395) and higher NDI (ρ=0.317) preoperatively were weakly correlated with elevated white blood cells. Postoperative improvement in MCS (ρ=0.306) and MCS recovery ratio (ρ=0.321) exhibited a weakly positive correlation with IL-6.

Conclusion: Preoperative cytokine levels demonstrated minimal correlation with preoperative symptoms or clinical improvement, suggesting that profiling of patient cytokines has limited utility in predicting outcomes after ACDF.

Level of evidence: Level III.

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Conflict of interest statement

A.S.H.: AAOS Board member or committee member; Amedica: IP royalties; Biomet: IP royalties; Paradigm spine: Stock or stock options. C.K.K.: Biomet: Research support; Clinical spine surgery: Editorial or governing board; Medtronic: Research support; Pfizer: Research support; Regeneration; Technologies, Inc.: Research support. A.R.V.: Advanced Spinal Intellectual Properties: Stock or stock Options; Aesculap: IP royalties; AO Spine: Board membership; Atlas Spine: IP royalties; Paid consultant; Avaz Surgical: Stock or stock Options; Bonovo Orthopaedics: Stock or stock Options; Clinical Spine Surgery: Editorial or governing board; Computational Biodynamics: Stock or stock Options; Cytonics: Stock or stock Options; DePuy, A Johnson & Johnson Company: Paid consultant; Dimension Orthotics LLC: Stock or stock Options; Electrocore: Stock or stock Options; Elsevier: Publishing royalties, financial or material support; Flagship Surgical: Stock or stock Options; FlowPharma: Stock or stock Options; Franklin Bioscience: Stock or stock Options; Gamma Spine: Stock or stock Options; Gerson Lehrman Group: Paid consultant; Globus Medical: IP royalties; Paid consultant; Stock or stock Options; Guidepoint; Global: Paid consultant; Innovative Surgical Design: Paid consultant; Stock or stock Options; Insight Therapeutics: Stock or stock Options; Jaypee: Publishing royalties, financial or material support; Medtronic: IP royalties; Paid consultant; none: Other financial or material support; Nuvasive: Paid consultant; Stock or stock Options; Orthobullets: Paid consultant; Paradigm Spine: Stock or stock Options; Parvizi Surgical Innovations: Stock or stock Options; Prime Surgeons: Stock or stock Options; Progressive Spinal Technologies: Stock or stock Options; Replication Medica: Stock or stock Options; Spine Journal: Editorial or governing board; Spine Medica: Stock or stock Options; SpineWave: IP royalties; Paid consultant; Spinology: Stock or stock Options; Stout Medical: Paid consultant; Stock or stock Options; Stryker: IP royalties; Paid consultant; Taylor Franics/Hodder & Stoughton: Publishing royalties, financial or material support; Thieme: Publishing royalties, financial or material support; Vertiflex: Stock or stock Options; Sentryx: Board membership. G.D.S.: Advance Medical: Paid consultant; AOSpine: Other financial or material support; Medtronic: Other financial or material support; Medtronic Sofamor Danek: Research support; Stryker: Paid consultant; Wolters Kluwer Health - Lippincott Williams & Wilkins: Editorial or governing board; Zimmer: Paid consultant. The remaining authors declare no conflict of interest.

References

    1. Matsumoto M, Fujimura Y, Suzuki N, Nishi Y, Nakamura M, Yabe Y, Shiga H, eds. MRI of cervical intervertebral discs in asymptomatic subjects. J Bone Joint Surg Br. 1998;80:19–24.
    1. Tracy JA, Bartleson JD. Cervical spondylotic myelopathy. Neurologist. 2010;16:176–187.
    1. Kim K-T, Kim Y-B. Cervical radiculopathy due to cervical degenerative diseases: anatomy, diagnosis and treatment. J Korean Neurosurg S. 2010;48:473–479.
    1. Nouri A, Tetreault L, Singh A, et al. Degenerative cervical myelopathy. Spine. 2015;40:E675–E693.
    1. Gutman G, Rosenzweig DH, Golan JD. Surgical treatment of cervical radiculopathy. Spine. 2018;43:E365–E372.

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