The predictive value of neutrophil-to-lymphocyte ratio in the efficacy of percutaneous lumbar disc radiofrequency ablation for lumbar disc herniation.

Abstract

Objective: To explore the predictive value of the Neutrophil-to-Lymphocyte Ratio (NLR) in the prognosis of patients with Lumbar Disc Herniation (LDH) undergoing Percutaneous Intradiscal Radiofrequency Thermocoagulation (PIRFT).

Methods: A total of 121 patients with LDH undergoing PIRFT treatment were selected, ranging in age from 35 to 65 years old, with no gender restrictions. Blood samples were collected in the morning after admission while fasting, and the absolute neutrophil and lymphocyte counts in the blood were detected using the enzyme-linked immunosorbent assay (ELISA) method to calculate the Neutrophil-to-Lymphocyte Ratio (NLR). Patients were divided into two groups according to the modified Macnab criteria: the Effective group (E group) and the Invalid group (I group). The Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores were used to assess the pain level and activity ability of the patients before treatment and at 90 days and 180 days post-treatment. The correlation between NLR and ODI, JOA scores was analyzed using rank correlation analysis, and the predictive value of NLR for the therapeutic effect of PIRFT was analyzed using the Receiver Operating Characteristic (ROC) curve.

Results: A total of 121 patients were ultimately enrolled. Based on the follow-up results at 90 days post-surgery, there were 110 cases in the effective group (E group) and 11 in the ineffective group (I group). The results showed that before treatment, the NLR levels in the E group were significantly lower than those in the I group (P < 0.05), and there were no significant differences in ODI and JOA scores between the two groups (P > 0.05). Ninety days after treatment, the NLR levels in the I group remained significantly higher than those in the E group (P < 0.05), and the E group's ODI and JOA scores showed significant improvement compared to before treatment (P < 0.05). In contrast, the I group only showed improvement in ODI scores (P < 0.05), with no significant change in JOA scores (P > 0.05). Additionally, the I group's ODI scores were significantly higher than those of the E group (P < 0.05), and their JOA scores were significantly lower than those of the E group (P < 0.05). All patients in the I group underwent a second radiofrequency ablation treatment. A comparison was made again after 180 days of treatment, and there were no significant differences in NLR levels between the two groups (P > 0.05). Both groups showed improvement in ODI and JOA scores compared to before treatment (P < 0.05), with no significant differences between the groups (P > 0.05). Rank correlation analysis showed that preoperative NLR levels were positively correlated with ODI scores at 90 days after PIRFT treatment (r = 0.386, P < 0.01) and negatively correlated with JOA scores (r = -0.326, P = 0.003). The results of the ROC curve analysis showed that the area under the ROC curve (AUC) was 0.803, the optimal diagnostic cutoff point was 1.975, the correct diagnosis index was 0.518, 95% CI: 0.650-0.955, P < 0.001.

Conclusion: Preoperative inflammatory levels are one of the factors affecting the treatment of lumbar disc herniation with percutaneous radiofrequency ablation, and the Neutrophil-to-Lymphocyte Ratio (NLR) helps to predict the effectiveness of percutaneous disc radiofrequency ablation in treating lumbar disc herniation.