Do Inflammatory Cytokines Affect Patient Outcomes After ACDF?

Authors

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

Publication/Presentation Date

5-1-2022

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.

Volume

35

Issue

4

First Page

137

Last Page

143

ISSN

2380-0194

Published In/Presented At

Karamian, B. A., Levy, H. A., Boere, P., Yalla, G. R., Canseco, J. A., Chang, M., Divi, S. N., Fang, T., Millhouse, P. W., Lendner, M., Hilibrand, A. S., Vaccaro, A. R., Kepler, C. K., Markova, D. Z., & Schroeder, G. D. (2022). Do Inflammatory Cytokines Affect Patient Outcomes After ACDF?. Clinical spine surgery, 35(4), 137–143. https://doi.org/10.1097/BSD.0000000000001318

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

35351842

Department(s)

Administration and Leadership

Document Type

Article