New research using unbiased serum proteomics, a state-of-the-art technique in orthopaedics, aims to predict which cervical radiculopathy patients will fail conservative treatment and consequently require surgery. The principal investigator Steven Presciutti (Department of Orthopaedics, Emory University School of Medicine, Atlanta, USA) presented the findings at the 45th Annual Meeting of the Cervical Spine Research Society (30th November – 2nd December, Florida, USA).
Presciutti and colleagues set out to identify novel biomarkers that would help distinguish between those cervical radiculopathy patients who would receive benefit from a cervical epidural steroid injection, and those whose symptoms would not resolve following this conservative treatment.
This is the first time serum proteomics has been utilised on this scale in specifically spine-related research, though it is already used in other areas of medical study. Presciutti describes serum proteomics as a “powerful, state-of-the-art analytical technique” that “holds a special key for biomarker discovery”. The power of this technique, he told Spinal News International, stems from the fact that “it goes way beyond just using one biomarker”, but rather uses many in order to paint a better picture of the underlying molecular mechanisms involved.
The technique enables surgeons to simultaneously measure up to 3,000 proteins circulating in the blood at any one time using mass spectrometry machines. These can then be used to determine a unique proteomic fingerprint, which may indicate an increased likelihood of failing conservative treatment.
Elucidating what makes patients who fail conservative treatment distinct from those whose symptoms resolve following a cervical epidural steroid injection would potentially enable surgeons to gain prognostic information, allowing for more informed decisions to be made earlier about whether surgery is necessary.
Current practice requires cervical radiculopathy patients to wait at least six to eight weeks of failed conservative treatment before surgery is offered, though Presciutti highlighted that this standard “has never been validated in the literature”.
Presciutti further commented, “there’s been recent evidence to show that surgery performed within eight weeks of symptom onset results in consistently better patient outcomes, as well as a significant decrease in the cost per QALY gained. And this decrease in health cost is particularly important given the fact that 80% of spinal medic healthcare costs in the US go toward conservative treatment.”
Emphasising the importance of serum proteomics, he continued: “we’re going to be seeing a lot more of these kinds of studies coming out in the very near future, because there’s already a lot of preliminary studies out there which, with success, use serum proteomics to help try to find these biomarker fingerprints for various spinal pathologies, whether that be lumbar radiculopathy, cervical myelopathy, even a study where they were able to reliably distinguish between chronic low back pain, discogenic back pain and radiculopathy.”