Outcome of lumbar epidural XXXX injection is predicted by assay of a complex of fibronectin and aggrecan from epidural lavage.

@entity1 @entity3976 @entity1797 @entity134 @entity615 @entity158 @entity2483 @entity614 @entity890
STUDY DESIGN: A single-center, prospective, consecutive case series of @entity1 undergoing epidural lavage before the treatment of @entity614 due to @entity890 . OBJECTIVE: To determine whether a novel complex of fibronectin and aggrecan predicts clinical response to epidural @entity134 injection (ESI) for the indication of @entity614 from lumbar @entity3976 ( @entity3976 ). SUMMARY OF BACKGROUND DATA: ESI for @entity614 due to @entity3976 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 @entity615 . We have previously investigated biomarkers of @entity1797 associated with @entity614 . METHODS: We embarked to determine whether a molecular complex of fibronectin and aggrecan predicts clinical response to ESI for the indication of @entity614 from @entity3976 . This prospective study was conducted at a single center and included 26 @entity1 with @entity158 and magnetic resonance imaging positive for @entity3976 , 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 @entity2483 ( @entity2483 ) score of the Medical Outcomes Study Short Form-36 instrument (SF-36) after injection compared with baseline. RESULTS: The mean improvement from baseline @entity2483 in @entity1 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 @entity2483 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 @entity614 with @entity3976 . The biomarker is accurate, objective, and not affected by demographic or psychosocial variables in this series.
